[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5031 Introduced in House (IH)]
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119th CONGRESS
1st Session
H. R. 5031
To amend title XVIII of the Social Security Act to temporarily provide
for long-term care pharmacy supply fees in connection with the
dispensing of certain drugs.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
August 22, 2025
Ms. Van Duyne (for herself, Mr. Schneider, Mr. Carter of Georgia, Ms.
Davids of Kansas, Mr. Jack, and Ms. Ross) introduced the following
bill; which was 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
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to temporarily provide
for long-term care pharmacy supply fees in connection with the
dispensing of certain drugs.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Preserving Patient Access to Long-
Term Care Pharmacies Act''.
SEC. 2. LONG TERM CARE PHARMACY SUPPLY FEE.
(a) In General.--Section 1860D-4(b)(1) of the Social Security Act
(42 U.S.C. 1395w-104(b)(1)) is amended by adding at the end the
following new subparagraph:
``(F) Long-term care pharmacy supply fees.--
``(i) Plan reimbursement to pharmacy.--
``(I) In general.--For plan years
2026 and 2027, for each specified
prescription dispensed by a long-term
care pharmacy to an enrollee during
such plan year, each PDP sponsor of a
prescription drug plan and each MA
organization offering an MA-PD plan
shall pay such pharmacy a supply fee in
an amount equal to--
``(aa) for plan year 2026,
$30; and
``(bb) for plan year 2027,
the amount of the supply fee
for the prior plan year,
increased by the annual
percentage increase described
in section 1860D-2(b)(6).
``(II) Clarification.--The supply
fee under this subparagraph shall be
paid at the same time and in addition
to any other pharmacy reimbursements,
including ingredient costs, dispensing
fees, or other payments negotiated
between the PDP sponsor or MA
organization and the long-term care
pharmacy, and shall not result in a
reduction to such other reimbursements.
``(ii) Enforcement.--
``(I) Civil money penalty.--The
Secretary shall impose a civil money
penalty on each PDP sponsor of a
prescription drug plan and MA
organization offering an MA-PD plan
that fails to pay a supply fee for a
specified prescription dispensed to an
enrollee in accordance with this
subparagraph for each such failure in
an amount of not less than $10,000.
``(II) Application.--The provisions
of section 1128A (other than
subsections (a) and (b)) shall apply to
a civil money penalty under this clause
in the same manner as such provisions
apply to a penalty or proceeding under
section 1128A(a).
``(iii) Definitions.--In this subparagraph:
``(I) Applicable maximum fair price
eligible individual.--The term
`applicable maximum fair price eligible
individual' means, with respect to a
specified prescription, a maximum fair
price eligible individual who, with
respect to such prescription, is
described in section 1191(c)(2)(A).
``(II) Long-term care pharmacy.--
The term `long-term care pharmacy'
means a pharmacy with a national
provider identifier associated with
taxonomy code 3336L0003X (or a
successor code), as maintained by the
National Uniform Claim Committee.
``(III) Maximum fair price.--The
term `maximum fair price' has the
meaning given such term in section
1191(c)(3).
``(IV) Maximum fair price eligible
individual.--The term `maximum fair
price eligible individual' has the
meaning given such term in section
1191(c)(2).
``(V) Specified prescription.--The
term `specified prescription' means a
covered part D drug dispensed by a
long-term care pharmacy to an
applicable maximum fair price eligible
individual at the maximum fair price
pursuant to section 1193(a)(3)(A).''.
(b) Repayment of Long-Term Pharmacy Supply Fees.--Section 1860D-15
of the Social Security Act (42 U.S.C. 1395w-115) is amended by adding
at the end the following new subsection:
``(i) Repayment of Long-Term Pharmacy Supply Fees.--
``(1) In general.--In addition to amounts otherwise payable
under this section to a PDP sponsor of a prescription drug plan
or an MA organization offering an MA-PD plan, for plan years
2026 and 2027, the Secretary shall provide the PDP sponsor or
MA organization offering the plan subsidies in an amount equal
to the aggregate amount of supply fees paid by such sponsor or
organization to long-term care pharmacies pursuant to section
1860D-4(b)(1)(F) during the plan year.
``(2) Timing.--The Secretary shall provide a subsidy under
paragraph (1), as applicable, not later than 18 months
following the end of the applicable plan year.''.
(c) GAO Study and Report.--
(1) In general.--Not later than 12 months after the date of
enactment of this section, the Comptroller General of the
United States shall complete a study and submit to Congress a
report on the economic sustainability of the participation of
long-term care pharmacies in the Medicare prescription drug
program. Such report shall include--
(A) an analysis of--
(i) payment to long-term care pharmacies
under the Medicare prescription drug program
with respect to--
(I) ingredient costs--
(aa) for brand-name drugs;
and
(bb) for generic drugs; and
(II) dispensing fees;
(ii) the costs to long-term care pharmacies
of compliance with the performance and service
criteria for network long-term care pharmacies,
as described in the Medicare Prescription Drug
Benefit Manual; and
(iii) changes to payment to long-term care
pharmacies under the Medicare prescription drug
program during the 5-year period preceding the
date of enactment of this section; and
(B) recommendations on steps that Congress and the
Secretary of Health and Human Services should consider
for purposes of creating a sustainable payment system
under the Medicare prescription drug program for long-
term care pharmacies that would ensure that Medicare
beneficiaries with long-term care needs have
uninterrupted access to long-term care pharmacy
services in all markets, particularly rural markets.
(2) Definitions.--In this subsection:
(A) Long-term care pharmacy.--The term ``long-term
care pharmacy'' has the meaning given such term in
subparagraph (F)(iii)(II) of section 1860D-4(b)(1) of
the Social Security Act (42 U.S.C. 1395w-104(b)(1)), as
added by subsection (a).
(B) Medicare beneficiary.--The term ``Medicare
beneficiary'' means an individual who is entitled to
benefits under part A of title XVIII of the Social
Security Act (42 U.S.C. 1395c et seq.) or enrolled
under part B of such title (42 U.S.C. 1395j et seq.).
(C) Medicare prescription drug program.--The term
``Medicare prescription drug program'' means the
program under part D of title XVIII of the Social
Security Act (42 U.S.C. 1395w-101 et seq.).
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