Congress quietly funds pharmacy bailout with taxpayer dollars
H.R. 5031 — Preserving Patient Access to Long-Term Care Pharmacies Act · Filed by Beth Van Duyne (R-TX) · 46 cosponsors · Introduced Aug 22, 2025 · Referred to committee
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What it does
This bill requires Medicare prescription drug plans to pay long-term care pharmacies an additional $30 per prescription in 2026 (and inflation-adjusted amounts in 2027), on top of existing reimbursements. The federal government will fully reimburse plans for these fees, meaning the cost is shifted to taxpayers rather than absorbed by insurers. The bill also mandates a GAO study on whether long-term care pharmacies can remain financially viable under current Medicare payment rates.
Why we flagged it
The bill's core mechanism is a federally-funded fee paid directly to long-term care pharmacies, with full taxpayer reimbursement to insurers. This is a targeted subsidy to a specific pharmacy sector, not a consumer protection or access-expansion measure with independent public-health justification.
What the text implies
- The $30 fee is arbitrary and not tied to actual cost data; the bill mandates a GAO study AFTER the fee takes effect, suggesting the amount was set without evidence.
- Full federal reimbursement to insurers means plans have no incentive to negotiate or challenge the fee—it is a pure pass-through cost to Medicare, insulating pharmacies from market discipline.
The full analysis lists 4 implications of this text.
Who stands to gain
long-term care pharmacies; specialty pharmacy operators; pharmacy benefit managers (indirectly, as they manage the subsidy flow)