Preserving Patient Access to Long-Term Care Pharmacies Act

This bill temporarily adds a supply fee for long-term care pharmacies when they dispense certain drugs to Medicare Part D enrollees at the maximum fair price, and requires a study on the economic sustainability of these pharmacies in the Medicare drug program.

Sec. 2, Long-term care pharmacy supply fee: For plan years 2026 and 2027, each Medicare Part D plan sponsor and Medicare Advantage plan offering Part D must pay a long-term care pharmacy a supply fee of $30 for 2026 and that amount increased by a specified annual percentage for 2027, for each specified prescription dispensed to an applicable maximum fair price eligible individual. The fee is paid in addition to other pharmacy reimbursements and cannot reduce them. The Secretary must impose a civil money penalty of at least $10,000 for each failure to pay the fee. The bill defines key terms including "long-term care pharmacy" (taxonomy code 3336L0003X), "specified prescription" (a covered Part D drug dispensed at the maximum fair price to an eligible individual), and "maximum fair price eligible individual."

Repayment of long-term pharmacy supply fees: For plan years 2026 and 2027, the Secretary must provide subsidies to plan sponsors and MA organizations equal to the total supply fees they paid to long-term care pharmacies during the plan year, with payment due no later than 18 months after the plan year ends.

GAO study and report: Within 12 months of enactment, the Comptroller General must study and report to Congress on the economic sustainability of long-term care pharmacies in Medicare Part D. The report must analyze payments for ingredient costs and dispensing fees for brand and generic drugs, compliance costs for network criteria, and payment changes over the prior 5 years. It must also recommend steps for Congress and the Health and Human Services Secretary to create a sustainable payment system ensuring uninterrupted access to long-term care pharmacy services, especially in rural markets.