Long Term Care & Senior Living Blog

The Centers for Medicare and Medicaid Services (CMS) has released a new proposed rule to reduce Medicare expenditures by changing the way it makes payments for Part B drugs. The proposal includes two phases. The first involves changing the percent of add-on to the Average Sales Price (ASP) of the drugs from 6% to 2.5% plus a flat fee payment. The second phase would utilize the value-based purchasing tools now used by commercial health plans, pharmacy benefit managers, hospitals and other entities that manage health benefits and drug utilization. The purpose of these proposed changes is to make Medicare spending on drugs more efficient while ensuring quality care for Medicare beneficiaries.

The Senior Care Pharmacy Coalition (SCPC) recently released a study comparing the differences between LTC and Retail Pharmacies. I thought this study may be of interest to some firm clients, who have LTC pharmacies as part of their businesses. Many assisted living facilities (ALFs) and skilled nursing facilities (SNFs) provide pharmacy services for residents in their facilities, as well as provide medication therapy management and other clinical offerings to help improve the quality of care. The differences between LTC pharmacy and retail pharmacy often result in greater costs being incurred by LTC pharmacies. To ensure the important role LTC pharmacies play in the healthcare continuum, it is important that lawmakers and regulators understand the differences demonstrated in the study. Here’s a link to the SCPC article, and a link to the actual study conducted by Avalere Health.