Bill > HR5031

This bill introduces a temporary measure to support long-term care pharmacies in the Medicare prescription drug program by establishing supply fees for specific prescriptions in 2026 and 2027. Under the bill, prescription drug plans (PDPs) and Medicare Advantage drug plans (MA-PD) will be required to pay long-term care pharmacies a supply fee of $30 in 2026, with the amount potentially increasing in 2027 based on an annual percentage adjustment. These fees will be paid in addition to existing reimbursements and will not reduce other pharmacy payments. The bill includes an enforcement mechanism with civil money penalties of at least $10,000 for plans that fail to pay the required fees. Additionally, the Secretary of Health and Human Services will provide subsidies to plans to cover these supply fees. The legislation also mandates a Government Accountability Office (GAO) study within 12 months of enactment to examine the economic sustainability of long-term care pharmacies in the Medicare prescription drug program, including an analysis of payment structures, compliance costs, and recommendations for creating a sustainable payment system that ensures Medicare beneficiaries have continuous access to long-term care pharmacy services, especially in rural markets.

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https://www.congress.gov/bill/119th-congress/house-bill/5031/all-info