H.R. 5031: Preserving Patient Access to Long-Term Care Pharmacies Act

This bill, titled the Preserving Patient Access to Long-Term Care Pharmacies Act, aims to make amendments to the Social Security Act with regard to long-term care pharmacies. Here’s a breakdown of its key provisions:

Long-Term Care Pharmacy Supply Fees

The bill introduces supply fees for long-term care pharmacies to ensure they are compensated for the medications they dispense. This includes the following points:

• From 2026 to 2027, long-term care pharmacies will receive a supply fee when they dispense certain specified prescriptions to patients. The fee will be:
• $30 for the year 2026.
• For 2027, the amount will be based on the previous year's fee, adjusted for inflation.
• The supply fee will be in addition to any other reimbursements the pharmacy receives for dispensing medications.
• If a prescription drug plan (PDP) or Medicare Advantage (MA) organization fails to pay this fee, they could face a civil penalty of at least $10,000.

Repayment of Long-Term Pharmacy Supply Fees

The act also stipulates that:

• The Secretary of Health and Human Services will provide subsidies to PDP sponsors or MA organizations equal to the total supply fees they have paid to long-term care pharmacies during those two years.
• This subsidy will be provided within 18 months after the end of each plan year.

GAO Study and Report

Within 12 months of the bill's enactment, the Government Accountability Office (GAO) is tasked with conducting a study that will include:

• Analysis of payments to long-term care pharmacies for:
• Ingredient costs for both brand-name and generic drugs.
• Dispensing fees.
• The costs associated with compliance to Medicare performance standards by long-term care pharmacies.
• Review of payment changes to pharmacies under the Medicare drug program over the past five years.
• Recommendations on how to sustain long-term care pharmacies' participation in Medicare, ensuring continuous access for beneficiaries, especially in rural areas.

Definitions

In the bill, several terms are defined for clarity, including:

• Long-term care pharmacy: A pharmacy that is officially recognized with a specific provider identifier related to their services.
• Medicare beneficiary: An individual entitled to Medicare benefits.
• Medicare prescription drug program: The program established under part D of the Social Security Act.

Relevant Companies

• None found