Preserving Patient Access to Long-Term Care Pharmacies Act
- Bill Number
- H.R. 5031
- Origin Chamber
- House
- Congress
- 119th Congress, Session 1
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2025-08-22: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- Last Updated
- 2026-06-26T08:06:57Z
AI-Generated Summary
Purpose of the Legislation
The "Preserving Patient Access to Long-Term Care Pharmacies Act" (H.R. 5031) aims to support long-term care pharmacies by introducing temporary supply fees for dispensing specific Medicare Part D drugs. Medicare Part D is the federal program that helps cover prescription drug costs for Medicare enrollees. This bill seeks to ensure these pharmacies remain financially viable, particularly for serving patients in long-term care settings like nursing homes, to maintain access to medications.
Key Provisions
- Supply Fee Requirement: For plan years 2026 and 2027, prescription drug plan (PDP) sponsors and Medicare Advantage-Prescription Drug (MA-PD) organizations must pay long-term care pharmacies a supply fee for each "specified prescription" dispensed.
- The fee is $30 in 2026 and increases in 2027 based on an annual adjustment tied to Medicare Part D benchmarks.
- A "specified prescription" is a covered Part D drug dispensed at the "maximum fair price" (a discounted price under the Inflation Reduction Act for certain high-cost drugs) to eligible Medicare enrollees who qualify for this pricing.
- The fee is paid at the same time as other reimbursements (like drug costs or dispensing fees) and does not reduce those payments.
- Enforcement Mechanism: Failure to pay the fee results in a civil money penalty (CMP) of at least $10,000 per violation, enforced by the Secretary of Health and Human Services (HHS). CMP rules follow existing procedures under Medicare law, excluding certain standard provisions for notice and appeals.
- Government Reimbursement: HHS must provide subsidies to PDP sponsors and MA-PD organizations equal to the total supply fees they paid out, within 18 months after each plan year ends. This offsets their costs.
- Definitions:
- Long-term care pharmacy: A pharmacy identified by a specific national provider code (3336L0003X or successor) used for billing long-term care services.
- Maximum fair price eligible individual: A Medicare enrollee qualifying for the discounted drug price under existing law.
- GAO Study and Report: The Government Accountability Office (GAO) must conduct a study within 12 months of enactment and report to Congress on the financial health of long-term care pharmacies in Medicare Part D. The report will analyze:
- Payments for drug ingredients (brand-name and generic) and dispensing fees.
- Compliance costs for network participation standards.
- Payment changes over the prior 5 years.
- Recommendations for sustainable payments to ensure uninterrupted access, especially in rural areas.
Significant Changes to Existing Law
- This bill amends the Social Security Act (Title XVIII, Sections 1860D-4 and 1860D-15) to create a new, temporary supply fee specifically for long-term care pharmacies handling maximum fair price drugs—a feature not previously mandated.
- It introduces direct subsidies from HHS to plans, ensuring the fees do not burden plan finances.
- Enforcement via CMPs is a new tool tailored to this context, building on but distinct from general Medicare fraud penalties.
- The GAO study is a novel requirement focused on long-term care pharmacy sustainability, which could influence future Medicare policy.
Potential Impacts
- Government Agencies: HHS will face administrative costs for subsidy payments, enforcement, and oversight. The GAO study may lead to broader policy recommendations, potentially increasing Medicare expenditures (estimated indirectly through subsidies matching pharmacy fees).
- Citizens: Medicare beneficiaries in long-term care, especially those needing high-cost drugs at maximum fair prices, could benefit from improved pharmacy access and reduced risk of service disruptions. Rural enrollees may see particular gains, as the bill emphasizes market sustainability.
- International Relations: No direct impacts, as this is a domestic Medicare policy.
Main Stakeholders Affected
- Long-term Care Pharmacies: Primary beneficiaries, receiving additional fees to cover operational costs like inventory and delivery in care facilities.
- Medicare Enrollees: Especially low-income or high-need individuals eligible for maximum fair price drugs, who rely on these pharmacies for timely access.
- PDP Sponsors and MA-PD Organizations: Required to pay fees but reimbursed by HHS, with potential administrative burdens; non-compliance risks penalties.
- HHS and GAO: Responsible for implementation, subsidies, enforcement, and the required study.
- Nursing Homes and Long-Term Care Facilities: Indirectly supported through reliable pharmacy partnerships.
Notable Legal, Constitutional, or Political Implications
- Legal: Strengthens Medicare Part D contracting by mandating fees and penalties, potentially setting a precedent for targeted pharmacy reimbursements. Ties into the Inflation Reduction Act's maximum fair price program, ensuring its implementation does not harm specialized pharmacies.
- Constitutional: No apparent issues; the bill operates within Congress's authority over federal spending and social welfare programs under the Social Security Act.
- Political: Bipartisan sponsorship (from both parties) highlights cross-aisle support for rural healthcare and Medicare sustainability. The temporary nature (2026-2027) and GAO study suggest it as a short-term fix, possibly paving the way for permanent reforms amid ongoing debates on drug pricing and pharmacy margins.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Rep. Van Duyne, Beth [R-TX-24]
Cosponsors (46)
Rep. Schneider, Bradley Scott [D-IL-10], Rep. Carter, Earl L. "Buddy" [R-GA-1], Rep. Davids, Sharice [D-KS-3], Rep. Jack, Brian [R-GA-3], Rep. Ross, Deborah K. [D-NC-2], Rep. Vindman, Eugene Simon [D-VA-7], Rep. Steube, W. Gregory [R-FL-17], Rep. Harder, Josh [D-CA-9], Rep. Comer, James [R-KY-1], Rep. Gonzales, Tony [R-TX-23], Rep. Gonzalez, Vicente [D-TX-34], Rep. Miller, Carol D. [R-WV-1], Rep. Fischbach, Michelle [R-MN-7], Rep. Sessions, Pete [R-TX-17], Rep. Bice, Stephanie I. [R-OK-5], Rep. Scholten, Hillary J. [D-MI-3], Rep. Taylor, David J. [R-OH-2], Rep. Finstad, Brad [R-MN-1], Rep. Mackenzie, Ryan [R-PA-7], Rep. Mannion, John W. [D-NY-22], Rep. Davis, Donald G. [D-NC-1], Rep. Barr, Andy [R-KY-6], Rep. LaLota, Nick [R-NY-1], Rep. Allen, Rick W. [R-GA-12], Rep. Kiggans, Jennifer A. [R-VA-2], Rep. Kelly, Mike [R-PA-16], Rep. Stauber, Pete [R-MN-8], Rep. Wittman, Robert J. [R-VA-1], Rep. Vasquez, Gabe [D-NM-2], Rep. Rogers, Harold [R-KY-5], Rep. Van Orden, Derrick [R-WI-3], Rep. LaHood, Darin [R-IL-16], Rep. Hinson, Ashley [R-IA-2], Rep. Feenstra, Randy [R-IA-4], Rep. McGuire, John J. [R-VA-5], Rep. Landsman, Greg [D-OH-1], Rep. Riley, Josh [D-NY-19], Rep. Rogers, Mike D. [R-AL-3], Rep. Lee, Susie [D-NV-3], Rep. Bell, Wesley [D-MO-1], Rep. Owens, Burgess [R-UT-4], Rep. Evans, Gabe [R-CO-8], Rep. Babin, Brian [R-TX-36], Rep. Bean, Aaron [R-FL-4], Rep. Fitzpatrick, Brian K. [R-PA-1], Rep. Tenney, Claudia [R-NY-24]
Recent Actions
- 2025-08-22: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- 2025-08-22: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- 2025-08-22: Introduced in House
- 2025-08-22: Introduced in House
Bill Versions
- Preserving Patient Access to Long-Term Care Pharmacies Act — issued 2025-08-22 — PDF (8 pages)