Argentum recently joined with AHCA/NCAL and LeadingAge to urge HHS and CMS to review potential unintended consequences due to changes to Medicare Part D drug pricing. We called on the administration to consider mitigating potential impacts through a demonstration project or waiver program, and for Congress to preemptively pass the Preserving Patient Access to Long-Term Care Pharmacies Act (H.R. 5031).
Starting in January 2026, some brand-name drug reimbursements will be subject to “negotiated” or “maximum fair” prices, in compliance with rules issued from the Inflation Reduction Act’s Medicare Part D drug negotiation program. The higher cost brand name drugs typically offset the costs of generic medication based on how pharmacy benefit managers structure payments. The drop in reimbursement for brand names threatens the financial stability of long-term care pharmacies, which would then threaten access for seniors who rely on these pharmacies as a result of facility closures especially in rural or underserved areas, and reduced services such as emergency delivery and consultant pharmacist services.
We are urging HHS Secretary Robert F. Kennedy, Jr. and CMS Administrator Mehmet Oz to mitigate this by implementing a demonstration project or waiver program under existing statutory authority. We are also calling for Congress to pass H.R. 5031, which would establish a temporary “supply fee” that LTC pharmacies would receive for each prescription of part D drugs that are under the negotiated price regime during 2026 and 2027 (set at $30 per prescription in 2026 and indexed to inflation).