Bill > S3159

This bill aims to support long-term care pharmacies by establishing a supply fee mechanism for Medicare prescription drug plans during the years 2026 and 2027. Specifically, the bill requires prescription drug plan (PDP) sponsors and Medicare Advantage prescription drug plan (MA-PD) organizations to pay long-term care pharmacies a supply fee of $30 per specified prescription in 2026, with the fee potentially increasing in 2027 based on an annual percentage increase. These supply fees are to be paid in addition to existing reimbursements and will not reduce other payment rates. The bill includes an enforcement mechanism with civil money penalties of at least $10,000 for plans that fail to pay the required fees, and mandates that the Secretary of Health and Human Services will provide subsidies to plans to cover these supply fees. Additionally, the bill requires the Government Accountability Office (GAO) to conduct a study within 12 months of enactment, analyzing the economic sustainability of long-term care pharmacies in the Medicare prescription drug program, including an examination of payment structures, compliance costs, and potential recommendations for creating a sustainable payment system that ensures Medicare beneficiaries maintain access to long-term care pharmacy services, particularly in rural markets.

Budget and Finance

https://www.congress.gov/bill/119th-congress/senate-bill/3159/all-info