Medicare quietly guarantees full reimbursement for pharmacy fee hike
S. 3159 — Preserving Patient Access to Long-Term Care Pharmacies Act · Filed by James Lankford (R-OK) · 4 cosponsors · Introduced Nov 7, 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 government will fully reimburse plans for these new fees, and the bill directs a study on whether long-term care pharmacies can sustainably participate in Medicare.
Why we flagged it
The bill's core mechanism is a mandated per-prescription fee paid by Medicare plans to long-term care pharmacies, fully reimbursed by the government. This is a targeted subsidy to a specific pharmacy sector, not a broad patient-access reform.
What the text implies
- The full reimbursement guarantee (Section 1860D–15) means insurers bear zero net cost, eliminating any incentive to negotiate or control the fee. The cost is entirely absorbed by Medicare, raising premiums or reducing other benefits.
- The bill applies only to 'specified prescriptions' (those at maximum fair price under Section 1193), creating a narrow carve-out that may not address broader long-term care pharmacy viability.
The full analysis lists 5 implications of this text.
Who stands to gain
long-term care pharmacies; pharmacy benefit managers (PBMs) managing MA-PD plans; Medicare Advantage organizations (indirect, via reimbursement guarantee)