Preserving Patient Access to Long-Term Care Pharmacies Act
Summary
The "Preserving Patient Access to Long-Term Care Pharmacies Act" aims to provide temporary financial relief to long-term care pharmacies by establishing supply fees for prescriptions dispensed to certain Medicare beneficiaries. This bill amends Title XVIII of the Social Security Act to include these fees for plan years 2026 and 2027. It also mandates a GAO study on the economic sustainability of long-term care pharmacies within the Medicare prescription drug program.
Expected Effects
The act will lead to increased reimbursement for long-term care pharmacies, specifically $30 per specified prescription in 2026, and an adjusted amount in 2027. PDP sponsors and MA organizations will be required to pay these fees, with the government providing subsidies to offset the costs. The GAO study will inform future policy decisions regarding long-term care pharmacy payments.
Potential Benefits
- Ensures continued access to long-term care pharmacy services for Medicare beneficiaries.
- Provides financial stability for long-term care pharmacies, particularly in rural areas.
- Offers additional reimbursement to pharmacies, covering supply costs.
- Requires a GAO study to assess the long-term economic sustainability of these pharmacies.
- Potentially improves the quality of care for residents in long-term care facilities.
Potential Disadvantages
- Increases costs for PDP sponsors and MA organizations, potentially leading to higher premiums for beneficiaries.
- The temporary nature of the supply fees (2026-2027) creates uncertainty for long-term planning.
- The definition of 'specified prescription' is limited, potentially excluding some beneficiaries from the benefits.
- Civil money penalties for non-compliance could burden smaller organizations.
- The GAO study may reveal underlying issues that require more comprehensive solutions.
Constitutional Alignment
The bill aligns with the General Welfare Clause of the Constitution, as it aims to ensure access to healthcare services for a vulnerable population. Specifically, it falls under Congress's power to tax and spend for the general welfare as outlined in Article I, Section 8. The Act does not appear to infringe upon any specific constitutional right or freedom.
Impact Assessment: Things You Care About ⓘ
This action has been evaluated across 19 key areas that matter to you. Scores range from 1 (highly disadvantageous) to 5 (highly beneficial).