| LTC Pharmacy News
April 2026 |
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| Hello Friends
Have you been watching, listening to, or reading the news? Gasoline at near all-time high prices, tariffs (coming and going), world turmoil, spiraling healthcare costs and complexity. The list goes on.
This month's news includes more mundane annual reviews of Medicare payment policy, newly-announced drug tariffs, new developments in the battle against obesity, and, surprisingly, a new federal assault against the dread fax machine.
The only hopeful thought that springs to mind is that all crises eventually end, followed by a season of adjustment and relative peace.
What can we do in the meantime? Devote yourself to learning new skills. You can become immune to much of the negative fallout of our current crisis if we prepare ourselves with knowledge. More on this is a future issue.
For now, don't give up. Your mission matters.
Paul |
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| | | | CMS Final Rule on 2027 Part D and MA Payment PoliciesThe final Medicare payment policies for Medicare Part D and Medicare Advantage plans have been published. CMS has granted the MA plans an increase of 2.48% and will seek to mitigate some of the alleged abuses of MA plans by requiring risk adjustment scores to be correlated with a patient encounter.Fact Sheet
CMS News Release
President Trump Imposes 100% Tariff on Imported Brand Name Drugs
The president signed an executive order imposing 100 percent tariffs on branded drugs imported to the US. If manufacturers commit to producing drugs in the US the tariffs will decrease to 20 percent. If they agree to also lowering prices the tariffs will decrease to zero. MoreCMS Terminates Faxes and Paper Mail (eventually)
A tool well familiar to LTC Pharmacies, the once-ubiquitous fax machine, has been found guilty of conspiracies against efficiency and will be declared obsolete effective March 26, 2028. A final rule to that effect was published recently and includes paper mail in its decree that these ancient means of communication will no longer be tolerated in the universe of medical communication. See story CMS Announcement
PBM Reform Programs Begin Rollout
The historic PBM reforms that were included in the FY 2026 spending legislation has begun to be implemented. The Dept. of Labor issued proposed rules requiring increased PBM disclosures for ERISA plans, and the Dept, of Justice achieved a legal settlement with Cigna (Express Scripts) related to the PBM's business practices. Provisions related to Medicare are scheduled to take effect in 2028.
MoreCMS Announces the First Wave of Health Technology Ecosystem
Noting the lag between technology advances and health system adoption, CMS has announced that it has begun the "first wave" of health system modernization by giving Medicare beneficiaries access to digital technologies. The notice includes a request for information. Read MoreLilly Oral GLP-1 Approved
The FDA approved Lilly's long-awaited oral formulation of its GLP-1 Drug, heating up the weight-loss market. The brand name is Foundayo (who thinks these up?), and it is expected to make life more difficult for Novo Nordisk, whose Wegovy oral was approved earlier. More
Lilly Launches Foundayo GLP-1 Direct to Consumers
Lilly's GLP-1 oral dosage form will be made available direct to consumers through its LillyDirect channel with telehealth support. https://www.fiercehealthcare.com/telehealth/eli-lillys-launches-oral-glp-1-drug-across-us-through-lilly-direct-telehealth-providers. Details
CMS Proposed 2027 SNF Payment Rule Released
CMS has published its proposed rule for 2027 PPS rates for Medicare SNF payments. The proposed net payment increase is 2.4%. The proposal also includes the removal of two COVID-19 measures and proposes a new requirement that all SNFs submit MDS data regardless of payer. More
HHS OIG Faults Nursing Homes over Antipsychotic Drug Use
The HHS Office of Inspector General reports on a recent recent nursing home surveys and has determined the practice of nursing homes ordering inappropriate antipsychotic meds to residents continues to be a problem. Among those criticized are the nursing home pharmacists who did not recommend corrective action. See Report |
| | | | | | Family Caregivers Provide More than $1 Trillion in Care
The nation's 59 million individuals who provide care for an adult family member, neighbor, or friend, invested more than 49 billion hours in 2024 providing care with an annual value of $1.01 trillion. This from an AARP report that reported the results of the survey. Most of this care was provided free. More
Medicare Negotiated Pricing Hits LTC Pharmacy
The beginning of the new year also marks the first year of the availability of negotiated pricing of prescription drugs in Medicare. Most of you are aware of this, but for those who may not, Skilled Nursing News did a good overview of the unintended consequences of this seemingly great idea.
Insurers Claim Prior Authorizations Down 11 Percent
The health insurance industry (AHIP and BCBS Association) reports that prior authorization requests from insurers is down 11 percent since the industry agreed to lower PA requirements in June 2025. See More
BrightSpring Sells Community Living Business to Sevita
Pharmerica parent company BrightSpring Health Services completed an $835 million sale of its community living portfolio to Sevita, a Minnesota-based community living operator. See More |
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