Premier and 55+ Organizations Call on CMS to Ensure Adequate Reimbursement for Long-Term Care Pharmacies

Premier, together with a coalition of 55+ aligned organizations and our Continuum of Care members, sent a letter to the Centers for Medicare & Medicaid Services (CMS) in response to the Contract Year (CY) 2027 Medicare Advantage (MA)/Prescription Drug Benefit (Part D) proposed rule, to explore new reimbursement models that fairly compensate long-term care pharmacies (LTCPs) for the specialized services they provide. To begin the process of transforming the current flawed reimbursement model, Premier and the 55+ signatories recommend that CMS pursue the following policies:

• Long-term: CMS should play a pivotal role as a convener to bring together key stakeholders and explore alternative reimbursement models with stand-alone and MA prescription drug plans (PDPs) to shift away from reimbursement methods based on the cost of drugs and instead reimburse LTCPs for the services they provide and health outcomes they achieve.
• Near-term: Strengthen CMS oversight by requiring PDPs to report data on LTCP beneficiaries to ensure they have adequate networks that meet LTCP standards.
• Near-term: Stratify Part D star measures by LTCP beneficiary to ensure fair comparison across different care environments and demonstrate the distinct care pattern LTCP beneficiaries receive.