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| Hope your summer was great. Congress has returned to a looming funding deadline, which has become routine over the past couple of decades. Federal spending authorization expires at the end of the fiscal year (Sept. 30) and without appropriations bills passed, the authorization to spend discretionary funds also expires. If the current drama follows precedent, something will be done to escape an emergency
A more urgent issue is on the near horizon for pharmacy, as January 1 brings a new year and the implementation of the reduction in acquisition cost to the federal government on drugs whose prices have been the subject of negotiation. Prices will lower and margins will disappear for pharmacies unless a solution is implemented.
To that end, legislation has been introduced to provide legislative release to LTC pharmacies, and Optum, United HealthGroup's PBM, has promised reimbursement increases to some independent pharmacies. Keep listening to your pharmacy associations, ASCP, SCPC and NCPA. These organizations are fighting to keep LTC pharmacy accessible to those who count on you.
Paul |
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| | | | Bill Introduced to Preserve LTC Pharmacies
The unintended consequences of Medicare price negotiation, specifically the impact on LTC pharmacy reimbursement, has resulted in the introduction of the Preserving Patient Access to Long-Term Care Pharmacies Act (HR 5031). The bipartisan legislation would compensate LTC pharmacies with a $30 fee. More.
HHS Reported to Have Drafted Rule to Repeal Nursing Home Staffing Requirement
The Trump Administration is reported to have drafted an interim final rule (without comment period and with immediate effect) that repeals the Biden Administration Nursing home staffing rule. The draft is reportedly under review at the Office of Management and Budget.
HR 3164 Gains Co-Sponsors
The industry-supported Ensuring Community Access to Pharmacist Services Act has added additional co-sponsors, now numbering 51 members of the House of Representatives.
Medicare Fee-for-Service to Test Prior Authorization
Beginning in 2026, CMS will introduce the WISeR Model in six states for Medicare FFS enrollees. WISeR is an acronym for Wasteful and Inappropriate Services Reduction, and establish electronic interventions for specific treatments or diagnostic procedures with notoriously suspicious efficacy. The states involved will be New Jersey, Oklahoma, Ohio, Texas, Arizona and Washington. See CMS
COVID-19 Immunizations Approved for Seniors
Updated COVID-19 vaccines are authorized for seniors this year, but the emergency use authorization for healthy children is no longer available. There are several conditions for which the vaccines are authorized, but only those recommended by the CDC are normally covered by insurance. CVS and Walgreens have announced that they will not offer vaccines to certain individuals, based on state regulations.
CMS Plans $75 Million Nursing Home Staff Training
CMS Administrator Dr, Mehmet Oz announced that he has notified state governors that he has moved ahead to create $75 million fund for tuition reimbursement and training for nursing home staff. McKnights.com
CMS Kicks Off $50 Billion Rural Health Transformation
CMS issued a press release announcing that states are now eligible to apply for grants available under the Tax Cuts for Working Families Act. The program allows states to transform the existing rural health care infrastructure and build sustainable health care systems that expand access, enhance quality of care, and improve outcomes for patients. |
| | | | Optum Increases Reimbursement Minimums for Some Pharmacies
Optum, the PBM subsidiary of health insurance giant United HealthGroup, announced that it has increased reimbursement for some drugs to independent pharmacies to combat the increased role of expensive medicines. Details
Nearly 20 Percent of Pharmacies Won't Stock Medicare Discount Drugs
NCPA released the results of a survey of independent pharmacists that discovered 19 percent of respondents indicated they would not be able to participate in dispensing drugs included in the Medicate negotiated drug discount program. Drug Topics
PhRMA Goes on the Attack on 340B Program
The drug manufacturing trade group has come out swinging in a national ad campaign to push for reforms to the 340B program. The focus is on what the PhRMA companies believe is unrestrained markups by hospitals on subsidized drug purchases.
SCPC CEO Warns About LTC Pharmacy Access
Alan Rosenbloom, CEO of the Senior Care Pharmacy Coalition, explains why a bill currently before Congress is the best hope for saving LTC pharmacies once the Medicare price-negotiated drug program kicks in next year. McKnights.com
KFF: Why More Older People are Dying After Falls
KFF notes the alarming rate of fatalities following senior falls and the probably relationship between these fatal falls and the increased use of some medications in the senior population.
KFF News
LTC Pharmacy Named to INC. 5,000 at #332
LTC Pharmacy company Lotus Pharmacy has been named the 332nd fastest growing company in the US, according to Inc. Magazine. The pharmacy is located in Minnesota and Jill Lytwyn is the founder and CEO. Congrats!
Select Pharmacy Expands to Assisted Living in Southern CA
Select Pharmacy announced that it will expand its service offerings to assisted living facilities in Southern California.
BrightSpring Posts Solid Q2 Earnings
Pharmerica parent BrightSpring Health Services exceeded analysts' expectations for 2nd quarter earnings with 29.1% increase in revenues over last year. More
ChatGPT-5 Useful for Healthcare: OpenAI
In unveiling its latest iteration of the Large Language Model ChatGPT-5, company CEO Sam Altman touted the new version as especially useful in healthcare, citing the tool's potential to enable patients to take charge of their health. More
Smartphones and Hemorrhoids
Seems like cell phones have had an extended streak of bad press. The latest? The Washington Post (subscription required) reports that extended smartphone use on the toilet is associated with an increased incidence of hemorrhoids. Apparently the affliction is not because of straining, but simply prolonged sitting. Seems as though scientists are determined to drain every last ounce of joy out of life. |
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