Preserving Patient Access to Long-Term Care Pharmacies Act
Sponsored By: Senator James Lankford
Introduced
Summary
Temporarily creates a per-prescription supply fee to keep long-term care pharmacies operating. The fee requires Medicare Part D plan sponsors and Medicare Advantage prescription drug plans to pay long-term care pharmacies $30 per specified prescription in plan year 2026 and an inflation-adjusted amount in plan year 2027.
Show full summary
- Long-term care pharmacies: Receive a $30 per-prescription supply fee in 2026 and a 2027 fee tied to the Part D annual increase. Payments must occur with other reimbursements and cannot reduce ingredient costs or dispensing fees.
- Plan sponsors and MA organizations: Must pay the fee when reimbursing LTC pharmacies and face a civil money penalty of at least $10,000 per failure. Sponsors are eligible for repayment subsidies equal to the aggregate supply fees they paid, with payments due no later than 18 months after the plan year ends.
- Patients and policymakers: Aims to preserve access to LTC pharmacy services, including in rural markets. The bill also requires a Government Accountability Office report within 12 months analyzing pharmacy ingredient costs, dispensing fees, network performance criteria, payment changes over the prior five years, and recommendations for a sustainable payment system.
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Bill Overview
Analyzed Economic Effects
1 provisions identified: 1 benefits, 0 costs, 0 mixed.
New fee for long-term care pharmacies
This bill would require Medicare drug plan sponsors to pay a per-prescription supply fee to long‑term care pharmacies for plan years 2026 and 2027. The fee would be $30 per covered "specified prescription" in 2026 and would increase in 2027 by the yearly percent set in statute. Plans must pay the fee at the same time as other reimbursements and may not reduce ingredient costs or dispensing fees. The government would repay each plan the total fees it paid for the plan year, with payments due within 18 months after the year ends. Failing to pay a required fee would trigger a civil money penalty of at least $10,000 per failure. The rule applies only to prescriptions dispensed by pharmacies that meet the long‑term care pharmacy definition and that are paid at the program's maximum fair price.
Sponsors & CoSponsors
Sponsor
James Lankford
OK • R
Cosponsors
Markwayne Mullin
OK • R
Sponsored 11/7/2025
Marsha Blackburn
TN • R
Sponsored 2/25/2026
Roll Call Votes
No roll call votes available for this bill.
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