A coalition representing the nation’s long-term care pharmacies is launching a new campaign to raise awareness of the “potentially devastating” consequences of new drug pricing policies on the industry and the residents it serves.
Save Senior Rx Care is a national advocacy and advertising campaign led by the Senior Care Pharmacy Coalition, which is urging Congress to protect access to medications and services for assisted living communities and nursing home residents. Such services include enhanced medication management, consultant services, resident/patient-specific packaging, heightened quality controls and around-the-clock delivery. The coalition also is asking lawmakers to create a sustainable payment model for long-term care pharmacies by January 2026, when the first round of the Inflation Reduction Act’s negotiated Medicare drug prices take effect.
The group released a white paper on Wednesday detailing its opinion on how recent Medicare drug pricing policy changes, pharmacy benefits manager actions and the pharmacy payment model could affect the future of long-term care pharmacies.
Assisted living communities or their residents will face the choice of higher costs for long-term care pharmacy services or a reduction in access to those services, according to the white paper.
“While it’s difficult to determine the precise number of assisted living residents who use long-term care pharmacy services, we do know that the complex care needs of residents in assisted living mirror the needs of residents in nursing facilities,” SCPC President and CEO Alan Rosenbloom told McKnight’s Senior Living. “As a result, a growing percentage of the 800,000 residents in assisted living facilities rely on long-term care pharmacies to provide the enhanced pharmacy services they need.”
Approximately 1,200 long-term care pharmacies dispense 200 million prescriptions annually to Medicare Part D beneficiaries annually, and long-term care residents take an average of 13 prescription medications, according to the coalition. In addition, 75% of long-term care pharmacy revenues come from Part D.
The American Rescue Plan of 2021 changed the formula for calculating rebates manufacturers must pay to state Medicaid programs when drug price increases outstrip inflation. That was followed by the Inflation Reduction Act in 2022, requiring the Centers for Medicare & Medicaid Services to negotiate drug prices with manufacturers for certain Medicare Part B and Part D drugs to reduce out-of-pocket expenses for Medicare enrollees.
Long-term care residents rely heavily on insulin, inhalers and eight of the fist 10 drugs subject to negotiated medicare pricing in 2026, according to the campaign. The SCPC said that many long-term care pharmacies will be forced to close in 2026 unless Congress addresses the new drug pricing policies and outdated reimbursement models.
A report released earlier this month by SCPC and ATI Advisory found that 53% of assisted living residents have more than four chronic conditions, and an additional 28% have two or three chronic conditions. According to the report, 63% of assisted living residents have high blood pressure, 32% have Alzheimer’s or dementia, 33% have depression, 25% have heart disease and 23% have diabetes.
Call to action
The coalition is calling on Congress to give CMS the direction and authority to “level the negotiating playing field.” The group is asking for assurances that Medicare Part D contracts allow long-term care pharmacies to maintain services by ensuring that Part D payments for services reflect the actual cost of those services — long-term care pharmacies receive an average reimbursement of $4 per prescription medication, compared with the $15 average cost to dispense on prescription.
The solution, the coalition said, must address the problem of “inadequate dispensing fees” and “unfair contracts and predatory market practices driven by disproportionate PBM market power.”
“The long-term care pharmacy model is flawed because PBM administered Medicare Part D plans require our pharmacies to subsidize inadequate payments for essential services with revenues from expensive brand name drugs,” Rosenbloom said. “Left unresolved, these new policies will make it nearly impossible for many long-term care pharmacies to continue serving patients, and the situation will only get worse as more brand-name drugs are subject to price negotiations each year.”
Martin Allen, senior vice president of reimbursement policy at the American Health Care Association / National Center for Assisted Living, told McKnight’s Senior Living that AHCA/NCAL supports the Save Senior Rx Care campaign.
“Long-term care pharmacies play a vital role in providing essential, life-saving medications for our nation’s seniors,” Allen said. “We support the Save Senior Rx Care campaign and urge Congress to safeguard these critical services to ensure our seniors continue to receive the highest quality of care and support they deserve.”
As part of SCPC’s Annual Summit in Washington, DC, this week, long-term care pharmacy representatives from across the nation are meeting with members of Congress to advocate for a sustainable Part D funding model for long-term care pharmacies.
