Support for Long-Term Care Pharmacies: Temporary Medicare Drug Supply Fees.
This Act introduces temporary, additional supply fees (starting at $30 in 2026) for long-term care pharmacies dispensing specific Medicare Part D drugs. This measure aims to ensure the financial stability of these pharmacies, which is vital for seniors and individuals with chronic needs, guaranteeing uninterrupted access to essential medications. Insurance plans failing to pay this fee will face financial penalties, and the government will reimburse the plans for these costs.
Key points
New Pharmacy Fee: For 2026 and 2027, long-term care pharmacies will receive an additional supply fee (starting at $30) for dispensing certain maximum fair price drugs under Medicare.
Ensuring Patient Access: The change is designed to maintain the economic viability of long-term care pharmacies, directly ensuring that Medicare beneficiaries have continuous access to necessary pharmacy services, especially in rural areas.
Mandate and Penalties for Insurers: Medicare insurance plans (PDP and MA-PD) are required to pay this fee, facing a civil money penalty of at least $10,000 for each failure to comply.
Government Reimbursement: The Secretary will provide subsidies to insurance plans, fully reimbursing them for the aggregate amount of these supply fees paid to long-term care pharmacies.
Future Study Mandate: The Act requires the GAO to study the economic sustainability of long-term care pharmacies in the Medicare program to inform the creation of a sustainable payment system.
Introduced
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