Preserving Patient Access to Long-Term Care Pharmacies Act
- Bill Number
- S. 3159
- Origin Chamber
- Senate
- Congress
- 119th Congress, Session 1
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2025-11-07: Read twice and referred to the Committee on Finance.
- Last Updated
- 2026-04-29T11:03:32Z
AI-Generated Summary
Purpose
The legislation, titled the "Preserving Patient Access to Long-Term Care Pharmacies Act," aims to temporarily support long-term care pharmacies (specialized pharmacies serving nursing homes and similar facilities) by requiring additional payments for dispensing certain Medicare Part D drugs. This is intended to help these pharmacies remain economically viable, ensuring continued access to medications for Medicare beneficiaries in long-term care settings, particularly in rural areas.
Key Provisions
- Supply Fee Requirement: For plan years 2026 and 2027, prescription drug plan (PDP) sponsors and Medicare Advantage-Prescription Drug (MA-PD) plan organizations must pay long-term care pharmacies a "supply fee" for each "specified prescription" (a covered Part D drug dispensed at the "maximum fair price" to eligible individuals). The fee starts at $30 in 2026 and adjusts for inflation in 2027 based on a standard Medicare percentage increase.
- Payment Details: This fee is paid alongside other reimbursements (like drug costs and dispensing fees) and does not reduce them. It applies only to prescriptions for "applicable maximum fair price eligible individuals" (Medicare enrollees qualifying for negotiated lower drug prices under existing law).
- Enforcement: Failure to pay the fee triggers civil money penalties of at least $10,000 per violation, enforced by the Secretary of Health and Human Services (HHS) using standard procedures similar to other Medicare penalties.
- Government Subsidies: HHS must reimburse PDP sponsors and MA-PD organizations for the total supply fees they pay out, with payments made no later than 18 months after the end of each plan year.
- Definitions:
- Long-term care pharmacy: A pharmacy identified by a specific national provider code (taxonomy code 3336L0003X) used for billing.
- Maximum fair price: The negotiated upper limit on drug prices for eligible Medicare beneficiaries, as defined in existing Medicare law.
- GAO Study and Report: The Government Accountability Office (GAO) must conduct a study within 12 months of enactment, analyzing payments to long-term care pharmacies (for brand-name and generic drugs, dispensing fees), compliance costs, and recent payment changes. The report will include recommendations to Congress and HHS for a sustainable payment system to maintain access to pharmacy services.
Significant Changes to Existing Law
- Amends Section 1860D-4(b)(1) of the Social Security Act to mandate these new supply fees, which were not previously required for these specific prescriptions.
- Adds a new subsection to Section 1860D-15, introducing direct subsidies from HHS to offset the fees, ensuring no net cost to plan sponsors.
- Introduces enforcement penalties and a required GAO study, which expand oversight and data collection on long-term care pharmacy finances under Medicare Part D (the voluntary prescription drug benefit program).
Potential Impacts
- On Government Agencies: HHS will handle enforcement, subsidy payments, and coordination with GAO, potentially increasing administrative workload but with built-in reimbursements to avoid long-term costs.
- On Citizens: Medicare beneficiaries in long-term care (e.g., nursing home residents) may benefit from stable pharmacy access, reducing risks of medication shortages, especially for high-cost drugs eligible for maximum fair pricing. Rural areas could see improved service continuity.
- On International Relations: No direct impact, as this is a domestic Medicare policy focused on U.S. healthcare providers and beneficiaries.
- Overall, the temporary fees and subsidies could stabilize pharmacy operations short-term, but long-term effects depend on the GAO recommendations.
Main Stakeholders Affected
- Long-Term Care Pharmacies: Primary beneficiaries, receiving extra revenue to cover supply and service costs.
- PDP Sponsors and MA-PD Organizations: Required to make payments but fully reimbursed by HHS, with penalties for non-compliance.
- Medicare Beneficiaries: Especially those in long-term care qualifying for maximum fair price drugs, gaining better access to essential medications.
- HHS and GAO: Responsible for implementation, enforcement, subsidies, and the sustainability study.
- Congress: Receives the GAO report to inform future Medicare Part D reforms.
Notable Legal, Constitutional, or Political Implications
- Legal: Strengthens Medicare Part D contracting rules with clear enforcement via civil penalties (modeled on existing fraud provisions), potentially setting a precedent for targeted pharmacy reimbursements. The temporary nature (two years) limits scope but ties into broader drug pricing reforms like the maximum fair price program.
- Constitutional: No apparent challenges; it operates within Congress's authority to regulate interstate commerce and spending under Medicare, without infringing on individual rights.
- Political: Bipartisan sponsorship (by Senators Lankford and Mullin) highlights focus on rural healthcare access. The GAO study could influence future legislation, addressing concerns about pharmacy closures amid rising drug costs, but the short-term subsidies avoid major budget debates.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Cosponsors (4)
Sen. Mullin, Markwayne [R-OK], Sen. Blackburn, Marsha [R-TN], Sen. Hyde-Smith, Cindy [R-MS], Sen. Capito, Shelley Moore [R-WV]
Recent Actions
- 2025-11-07: Read twice and referred to the Committee on Finance.
- 2025-11-07: Introduced in Senate
Bill Versions
- Preserving Patient Access to Long-Term Care Pharmacies Act — issued 2025-11-07 — PDF (8 pages)