I 
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 dis-
pensing 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 sub-
sequently 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 tempo-
rarily 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 Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Preserving Patient Ac-
cess to Long-Term Care Pharmacies Act’’. 
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SEC. 2. LONG TERM CARE PHARMACY SUPPLY FEE. 
(a) IN GENERAL.—Section 1860D–4(b)(1) of the So-
cial Security Act (42 U.S.C. 1395w–104(b)(1)) is amend-
ed by adding at the end the following new subparagraph: 
‘‘(F) LONG-TERM CARE PHARMACY SUPPLY 
FEES.— 
‘‘(i) PLAN REIMBURSEMENT TO PHAR-
MACY.— 
‘‘(I) IN
GENERAL.—For plan 
years 2026 and 2027, for each speci-
fied 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). 
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‘‘(II) CLARIFICATION.—The sup-
ply fee under this subparagraph shall 
be paid at the same time and in addi-
tion to any other pharmacy reim-
bursements, 
including 
ingredient 
costs, dispensing fees, or other pay-
ments 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 sub-
paragraph for each such failure in an 
amount of not less than $10,000. 
‘‘(II) APPLICATION.—The provi-
sions of section 1128A (other than 
subsections (a) and (b)) shall apply to 
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a civil money penalty under this 
clause in the same manner as such 
provisions apply to a penalty or pro-
ceeding under section 1128A(a). 
‘‘(iii) DEFINITIONS.—In this subpara-
graph: 
‘‘(I) APPLICABLE MAXIMUM FAIR 
PRICE
ELIGIBLE
INDIVIDUAL.—The 
term ‘applicable maximum fair price 
eligible individual’ means, with respect 
to a specified prescription, a max-
imum fair price eligible individual 
who, with respect to such prescription, 
is described in section 1191(c)(2)(A). 
‘‘(II) LONG-TERM
CARE
PHAR-
MACY.—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 Com-
mittee. 
‘‘(III) MAXIMUM FAIR PRICE.— 
The term ‘maximum fair price’ has 
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the meaning given such term in sec-
tion 1191(c)(3). 
‘‘(IV) MAXIMUM FAIR PRICE ELI-
GIBLE INDIVIDUAL.—The term ‘max-
imum fair price eligible individual’ has 
the meaning given such term in sec-
tion 1191(c)(2). 
‘‘(V) 
SPECIFIED
PRESCRIP-
TION.—The term ‘specified prescrip-
tion’ means a covered part D drug 
dispensed by a long-term care phar-
macy to an applicable maximum fair 
price eligible individual at the max-
imum 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 SUP-
PLY FEES.— 
‘‘(1) IN
GENERAL.—In addition to amounts 
otherwise payable under this section to a PDP spon-
sor of a prescription drug plan or an MA organiza-
tion offering an MA–PD plan, for plan years 2026 
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and 2027, the Secretary shall provide the PDP 
sponsor or MA organization offering the plan sub-
sidies 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 com-
plete a study and submit to Congress a report on 
the economic sustainability of the participation of 
long-term care pharmacies in the Medicare prescrip-
tion drug program. Such report shall include— 
(A) an analysis of— 
(i) payment to long-term care phar-
macies under the Medicare prescription 
drug program with respect to— 
(I) ingredient costs— 
(aa) for brand-name drugs; 
and 
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(bb) for generic drugs; and 
(II) dispensing fees; 
(ii) the costs to long-term care phar-
macies of compliance with the performance 
and service criteria for network long-term 
care pharmacies, as described in the Medi-
care Prescription Drug Benefit Manual; 
and 
(iii) changes to payment to long-term 
care pharmacies under the Medicare pre-
scription drug program during the 5-year 
period preceding the date of enactment of 
this section; and 
(B) recommendations on steps that Con-
gress and the Secretary of Health and Human 
Services should consider for purposes of cre-
ating 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, particu-
larly rural markets. 
(2) DEFINITIONS.—In this subsection: 
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(A) LONG-TERM
CARE
PHARMACY.—The 
term ‘‘long-term care pharmacy’’ has the mean-
ing 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 PRO-
GRAM.—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.). 
Æ 
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