This bill establishes a mandatory supply fee paid by Medicare drug plans to long-term care pharmacies for specific prescriptions in 2026 and 2027, while also mandating a GAO study on the financial sustainability of the current payment system.
Beth Van Duyne
Representative
TX-24
This Act establishes a mandatory supply fee for Medicare drug plans to pay long-term care pharmacies for specific prescriptions dispensed in 2026 and 2027. The bill mandates a $30 fee per prescription in 2026, increasing in 2027, with penalties for non-payment. Additionally, the GAO is required to study the financial sustainability of the current payment structure for these essential pharmacies. This legislation aims to ensure continued access to medications for patients in long-term care settings.
New Medicare Rule Mandates $30 Supply Fee for Long-Term Care Pharmacies Starting 2026, Backed by Federal Subsidy
This bill, officially titled the Preserving Patient Access to Long-Term Care Pharmacies Act, is all about making sure specialized pharmacies that serve long-term care patients—think nursing homes and assisted living—can keep their lights on. Starting in 2026, it mandates a temporary, extra payment for these pharmacies when they dispense certain prescriptions.
The $30 Lifeline: What the Bill Does
Starting in 2026, Medicare prescription drug plans (Part D and MA/MAPD plans) must pay a special supply fee of $30 to long-term care pharmacies for every “specified prescription.” That fee increases slightly in 2027. A "specified prescription" is basically a drug dispensed by a long-term care pharmacy (which is defined by a specific national provider code) to a patient who is eligible for the government’s maximum fair price program. The key here is that this new fee must be paid on top of the current reimbursement rates. Plans are explicitly forbidden from using this $30 fee as an excuse to lower the negotiated price they pay for the drug ingredient or the standard dispensing fee. This is a direct financial boost aimed squarely at pharmacies that specialize in this often-complex area of care.
The Catch: Who Pays and When
If you’re running a Medicare plan, this bill has a serious bite. If a plan fails to pay this required supply fee correctly, the Department of Health and Human Services (HHS) can hit them with a civil money penalty starting at no less than $10,000 for every single failure. That’s a huge incentive for plans to get their payment systems right. However, the bill shifts the ultimate cost burden: the Secretary of HHS must reimburse the plans for the total amount of supply fees they paid out. The catch? This reimbursement can take up to 18 months after the plan year ends. So, while Medicare plans aren't ultimately footing the bill, they have to front the cash for a year or more, creating a significant temporary cash flow issue and major administrative liability.
Why the Sudden Fee? The Sustainability Question
The reason for this temporary, mandated fee is stability. Long-term care pharmacies often have higher operating costs due to specialized packaging, delivery schedules, and regulatory compliance. The bill acknowledges this by directing the Government Accountability Office (GAO) to conduct a major study on the financial sustainability of these pharmacies. The GAO needs to analyze how much they are currently paid versus their actual costs and suggest long-term solutions to ensure patients—especially those in rural areas—don't lose access to their medications. This temporary $30 fee acts as a financial bridge for 2026 and 2027 while the government figures out a permanent fix. For a senior citizen relying on a long-term care facility, this means the specialized pharmacy serving them has a better chance of staying in business, theoretically ensuring their prescriptions arrive on time and correctly packaged.