HR5031-119

What This Bill Does

The Preserving Patient Access to Long-Term Care Pharmacies Act creates a temporary Medicare Part D supply fee for long-term care pharmacies. For plan years 2026 and 2027, each PDP sponsor and MA organization offering an MA-PD plan must pay a long-term care pharmacy a supply fee for each specified prescription dispensed to an eligible enrollee at the maximum fair price. The 2026 fee is $30; the 2027 fee is the prior-year fee increased by the annual percentage increase used in Part D. The fee must be paid at the same time and in addition to ingredient costs, dispensing fees, and other negotiated reimbursements, and it cannot reduce those other reimbursements. HHS must impose civil money penalties of at least $10,000 for each failure to pay. Medicare then provides subsidies to plans equal to the aggregate supply fees paid, not later than 18 months after the plan year. GAO must report within 12 months on long-term care pharmacy payment, compliance costs, five-year payment changes, and recommendations for a sustainable payment system, particularly in rural markets.

Who Benefits and How

Long-term care pharmacies benefit from a required $30 per-prescription supply fee in 2026 and an inflation-updated fee in 2027. Medicare beneficiaries with long-term care needs benefit if the fee helps preserve pharmacy access in all markets, especially rural markets. Rural long-term care facilities benefit if pharmacies remain financially able to serve residents under Part D. PDP sponsors receiving subsidies benefit because Medicare reimburses aggregate supply fees paid to long-term care pharmacies.

Who Bears the Burden and How

PDP sponsors must pay the required supply fee and face at least $10,000 in civil money penalties for each failure. MA-PD organizations must make the same fee payments without reducing other reimbursements. CMS Part D administrators must subsidize plans for aggregate supply fees and enforce civil money penalties. GAO health care analysts must study long-term care pharmacy economics and report recommendations within 12 months.

Key Provisions

• Requires a $30 long-term care pharmacy supply fee for plan year 2026.
• Requires the 2027 supply fee to increase by the Part D annual percentage increase.
• Bars plans from reducing ingredient costs, dispensing fees, or other reimbursements because of the supply fee.
• Creates civil money penalties of at least $10,000 for each failure to pay.
• Provides federal subsidies to plans for aggregate supply fees and requires a GAO sustainability report.