S. 3159: 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 changes to the Medicare prescription drug program, particularly for long-term care pharmacies. Here’s how it works in layman's terms:

Key Provisions

• Supply Fees for Pharmacies: Starting in 2026 and continuing into 2027, Medicare will require that certain prescription drug plans pay long-term care pharmacies a supply fee for each specified prescription they dispense. Specifically:
  • In 2026, the fee will be set at $30 for each prescription.
  • In 2027, this fee will increase based on annual inflation rates.
  • This fee is in addition to any other reimbursements that pharmacies may receive, such as the cost of the medication or dispensing fees.
• Punitive Measures for Non-Compliance: If a prescription drug plan does not pay the required supply fee, the Secretary of Health will impose a civil penalty of at least $10,000 for each failure to comply.
• Subsidies for Drug Plans: To help offset the costs of these supply fees, the federal government will provide subsidies to the prescription drug plans during 2026 and 2027. These subsidies will cover the total amount paid in supply fees by the plans, ensuring that they can continue offering long-term care pharmacy services without incurring losses.
• Study on Economic Sustainability: The bill requires a study to be conducted by the Comptroller General within 12 months after it is enacted. This study will focus on the financial sustainability of long-term care pharmacies within the Medicare program. It will analyze various factors, including:
  • Payments to pharmacies for both brand-name and generic drugs.
  • The costs associated with meeting service criteria set by Medicare.
  • Changes in payments to pharmacies over the last five years.
  The findings will also include recommendations for creating a sustainable payment system to ensure continuous access to long-term care pharmacy services, particularly in rural areas.

Definitions

For clarity, the bill includes definitions of key terms, including:

• Long-term Care Pharmacy: Defined as a pharmacy that meets certain criteria set by Medicare.
• Medicare Beneficiary: An individual entitled to Medicare benefits.
• Medicare Prescription Drug Program: Refers to the drug coverage provided under Medicare Part D.

Implementation Timeline

These provisions are set to take effect starting in plan years 2026 and 2027, with subsequent evaluation and reporting based on their effectiveness and sustainability.

Relevant Companies

• None found.