Trump Could Move to Shield Seniors As Biden’s IRA Triggers Long-Term Care Pharmacy Crisis

As we fast approach the end of the year, legislators and others are sounding the alarm bells on a Biden administration provision in the Inflation Reduction Act (IRA) that could spell doom for long-term care (LTC) pharmacies and the American seniors they serve.

Thankfully, the Trump administration is aware of this looming disaster and has options to act — options that will help protect Americans and lower taxpayer costs.

What Are LTCs?

Long-term care pharmacies are small, specialized pharmacies that often operate behind the scenes, managing medications for nursing homes, skilled nursing facilities, assisted living facilities, and hospices. They provide medications, manage prescriptions, coordinate with facility staff, deliver medications, and provide around-the-clock support. The vast majority of the people they serve are seniors, often disabled and dependent on medications. They are a vital part of the network that provides care for the most needy, vulnerable Americans.

What the Inflation Reduction Act Does

Starting January 1, 2026, provisions in the IRA allow the federal government to negotiate lower drug prices for certain Medicare Part D-covered medications. This means that, starting in the new year, “maximum fair prices” will apply to certain expensive, name-brand drugs. Those are the kinds of drugs that are often prescribed in long-term-care settings.

The current reimbursements from those drugs help LTC pharmacies offset the costs for the less expensive, high-volume drugs used by seniors. In short, LTC pharmacies rely on the revenue from those higher-cost drug reimbursements to stay afloat, and they stand to lose a lot of money in just a few short weeks.

This serious financial hit means LTC pharmacies could see their operating margins decline by about 35 percent by 2027, driving many to reduce services or even shut down. According to the Senior Care Pharmacy Coalition (SCPC), as many as 60 percent of LTC pharmacies could close without a change to the IRA provisions. For LTC pharmacies that don’t close, SCPC warns that up to 90 percent of pharmacy staff could be laid off, and 80 percent would be forced to reduce services and raise charges.

Such closures would create nothing short of a crisis in long-term care facilities and put the lives and health of seniors at risk. This means seniors could face medication delays, missed doses, reduced clinical oversight, and lower quality of care.

Retail pharmacies like Walgreens and CVS have different revenue streams and would be far less impacted by these decisions. Meanwhile, Medicare spending would increase anywhere from $1.9 to $4.8 billion over the next decade because seniors negatively impacted by this provision would require more hospitalizations and ER visits.

“Poison Pill” Provision

Another problem with this provision is that nursing homes and other facilities are required by federal law to contract with LTC pharmacies, meaning they cannot — under the law — seek alternative services to help seniors get the medication they need and the care they deserve. If these facilities can’t meet federal requirements, they would be forced to shut down. That would leave millions of seniors homeless and countless families scrambling to find care for their loved ones.

According to a source close to the Trump administration said, “The Biden administration left a number of trap doors of bad policies and they were hoping President Trump would fall into them ahead of the election. Thankfully, there is a whole-of-government effort to fix and replace the broken, government-run health care system the Democrats imposed on America.

Democrats would, undoubtedly, run on any disruptions to healthcare for seniors in 2026 and blame President Trump, even though the policy originated under the Biden administration.

“The reality is on anything health care,” said one GOP strategist, “the ads would write themselves. President Trump has delivered one of the most impressive records of wins in modern American history, and every Republican candidate is lucky to be able to run on his accomplishments. However, voters won’t care much about that record if they can’t access their medication and their families are being burdened by a wave of nursing home closures. This needs to be fixed ASAP.”

Here Are the Solutions

The good news is that there are options that the Trump administration can explore and implement to prevent the Biden administration from further harming Americans. 

First, the Centers for Medicare & Medicaid Services (CMS) could use existing Section 402 authority to establish a temporary $30 dispensing fee for LTC pharmacies, limited to IRA-impacted drugs. With this, precedent already exists under both Democrats and Republicans for creating this provision with a two-year sunset date.

Second, the bipartisan Preserving Patient Access to Long-Term Care Pharmacies Act could be added to any year-end ACA subsidy package. That legislation would also create a “supply fee” to LTC pharmacies. For 2026 and 2027, LTC pharmacies would get an additional $30 per prescription for eligible drugs in addition to normal reimbursements for drug costs and dispensing fees. After those two years, the fee would increase based on inflation. The legislation also imposes a $10,000 civil penalty per violation if a Medicare drug plan or Medicare Advantage Part D plan fails to pay the fee.The bill would also call for a study on the sustainability of LTC pharmacies under the new drug pricing schedule to create recommendations for longer-term payment systems that would preserve access, including in rural areas.

Call to Action

Several former and current legislators, as well as others, are calling on the Trump administration to act. The Preserving Patient Access to Long-Term Care Pharmacies Act was introduced by Senators James Lankford (R-OK) and Markwayne Mullin (R-OK). In a statement, Sen. Lankford said, “Seniors in long-term care facilities in Oklahoma and across the nation should never have to worry about access to the daily medicines they rely on. Long-term care pharmacies provide essential, specialized services, and it’s critical that we protect them and ensure they can remain in our communities. That’s why I’m proud to lead legislation that will keep long-term care pharmacies in operation and serving patients.”

Sen. Mullin added, “Long-term care pharmacies are essential to the health and safety of our seniors, especially in rural communities across Oklahoma. I’m proud to be working together on this necessary fix to ensure vulnerable seniors across our state receive the care they need without interruption.”

Writing for McKnight’s Long-Term Care News, Kimberly Marsela warned of “devastating consequences” if Congress doesn’t act. 

Without relief from Congress, the impact will grow when another 15 drug prices are lowered in 2027. The second-year drugs account for $1.52 billion of LTC pharmacy revenue in the analysis, versus $2.77 billion for the first-year drugs whose new prices go into effect Jan. 1.

The IRA authorized the price negotiations and ultimately resulted in capped payment formulas that subject LTC pharmacies to compensation far below current reimbursement levels.

Leaders at the Senior Care Pharmacy Coalition and the American Society of Consultant Pharmacists have previously told McKnight’s Long-Term Care News that LTC pharmacists deliver eight of the 10 drugs whose prices were negotiated in the first round. Dispensing those name-brand drugs has traditionally helped offset the government’s general preference for lower-cost generics in long-term care; the lower negotiated prices on expensive brand-name medicines undercut the delicate payment balance.

Alan Rosenbloom, president and CEO of SCPC said in a statement, “This new report confirms what we already know: LTC pharmacies and the patients they serve face devastating consequences in 2026 that will worsen appreciably in 2027 without immediate relief from policymakers in Washington.”

Republican State Rep. Cody Huneycutt (NC-67) also expressed his concerns about these changes in an op-ed for NC Political News.

Here’s why these matters: In North Carolina, over 160,000 beneficiaries of Medicare Part D have long-term care needs, meaning they live with chronic diseases or illnesses and can no longer fully care for themselves. These residents depend on the state’s 54 specialized LTC pharmacies to manage their complex medication regimens which can average 12-13 prescriptions daily per person.

Now, you might be thinking, “What’s the difference between these pharmacies and the one I go to?” It’s a fair question. Long-term care pharmacies are fundamentally different from the retail pharmacies most of us use. These pharmacies mainly serve nursing homes and assisted living facilities, providing round the clock emergency medication access. They deliver medications across long distances, manage specialized packaging, and handle the complex medical needs of long-term care patients. They also help nursing homes and assisted living facilities stay in compliance with federal law that requires these facilities to have pharmaceutical services.

…

That’s why we need immediate action—whether through legislation or administrative measures—to protect seniors’ access to the pharmacy care they depend on. I strongly support the Preserving Patient Access to Long-Term Care Pharmacies Act (H.R. 5031) as a critical step toward solving this problem.

Former Pennsylvania state lawmaker Will Tallman also called for action. In an op-ed in The Sentinel, Tallman wrote, “The damage will be felt everywhere, but the worse consequences will land squarely on rural Pennsylvania, where 11 out of the 72 LTC pharmacies are currently situated. If one pharmacy is forced to close, senior facilities will instantly lose the pharmaceutical services that are mandated by federal code. Without these services, these facilities cannot remain open. If these LTC pharmacies collapse, the senior homes they support will follow. And if those facilities close, rural families will have nowhere to turn.”

Writing for The Gazette in Iowa, former health care administrator Kelley Koch called on President Trump to “right Biden’s wrongs” on the issue.

“As a former health care administrator, I’m deeply concerned about an impending consequence brought on by Biden’s Inflation Reduction Act that threatens seniors in nursing homes and assisted living facilities,” Koch wrote. “Without these pharmacies, nursing homes may be unable to meet federal requirements and could be forced to close themselves, particularly in rural areas where a single pharmacy closure could impact multiple facilities serving our most vulnerable seniors.”

“Time is running out — Washington must act to protect our seniors,” Koch concluded.

Editor’s Note: Do you enjoy Townhall’s conservative reporting that takes on the radical left and woke media? Support our work so that we can continue to bring you the truth.

Join Townhall VIP and use the promo code FIGHT to get 60% off your VIP membership!

As we fast approach the end of the year, legislators and others are sounding the alarm bells on a Biden administration provision in the Inflation Reduction Act (IRA) that could spell doom for long-term care (LTC) pharmacies and the American seniors they serve.

Thankfully, the Trump administration is aware of this looming disaster and has options to act — options that will help protect Americans and lower taxpayer costs.

What Are LTCs?

Long-term care pharmacies are small, specialized pharmacies that often operate behind the scenes, managing medications for nursing homes, skilled nursing facilities, assisted living facilities, and hospices. They provide medications, manage prescriptions, coordinate with facility staff, deliver medications, and provide around-the-clock support. The vast majority of the people they serve are seniors, often disabled and dependent on medications. They are a vital part of the network that provides care for the most needy, vulnerable Americans.

What the Inflation Reduction Act Does

Starting January 1, 2026, provisions in the IRA allow the federal government to negotiate lower drug prices for certain Medicare Part D-covered medications. This means that, starting in the new year, “maximum fair prices” will apply to certain expensive, name-brand drugs. Those are the kinds of drugs that are often prescribed in long-term-care settings.

The current reimbursements from those drugs help LTC pharmacies offset the costs for the less expensive, high-volume drugs used by seniors. In short, LTC pharmacies rely on the revenue from those higher-cost drug reimbursements to stay afloat, and they stand to lose a lot of money in just a few short weeks.

This serious financial hit means LTC pharmacies could see their operating margins decline by about 35 percent by 2027, driving many to reduce services or even shut down. According to the Senior Care Pharmacy Coalition (SCPC), as many as 60 percent of LTC pharmacies could close without a change to the IRA provisions. For LTC pharmacies that don’t close, SCPC warns that up to 90 percent of pharmacy staff could be laid off, and 80 percent would be forced to reduce services and raise charges.

Such closures would create nothing short of a crisis in long-term care facilities and put the lives and health of seniors at risk. This means seniors could face medication delays, missed doses, reduced clinical oversight, and lower quality of care.

Retail pharmacies like Walgreens and CVS have different revenue streams and would be far less impacted by these decisions. Meanwhile, Medicare spending would increase anywhere from $1.9 to $4.8 billion over the next decade because seniors negatively impacted by this provision would require more hospitalizations and ER visits.

“Poison Pill” Provision

Another problem with this provision is that nursing homes and other facilities are required by federal law to contract with LTC pharmacies, meaning they cannot — under the law — seek alternative services to help seniors get the medication they need and the care they deserve. If these facilities can’t meet federal requirements, they would be forced to shut down. That would leave millions of seniors homeless and countless families scrambling to find care for their loved ones.

According to a source close to the Trump administration said, “The Biden administration left a number of trap doors of bad policies and they were hoping President Trump would fall into them ahead of the election. Thankfully, there is a whole-of-government effort to fix and replace the broken, government-run health care system the Democrats imposed on America.

Democrats would, undoubtedly, run on any disruptions to healthcare for seniors in 2026 and blame President Trump, even though the policy originated under the Biden administration.

“The reality is on anything health care,” said one GOP strategist, “the ads would write themselves. President Trump has delivered one of the most impressive records of wins in modern American history, and every Republican candidate is lucky to be able to run on his accomplishments. However, voters won’t care much about that record if they can’t access their medication and their families are being burdened by a wave of nursing home closures. This needs to be fixed ASAP.”

Here Are the Solutions

The good news is that there are options that the Trump administration can explore and implement to prevent the Biden administration from further harming Americans. 

First, the Centers for Medicare & Medicaid Services (CMS) could use existing Section 402 authority to establish a temporary $30 dispensing fee for LTC pharmacies, limited to IRA-impacted drugs. With this, precedent already exists under both Democrats and Republicans for creating this provision with a two-year sunset date.

Second, the bipartisan Preserving Patient Access to Long-Term Care Pharmacies Act could be added to any year-end ACA subsidy package. That legislation would also create a “supply fee” to LTC pharmacies. For 2026 and 2027, LTC pharmacies would get an additional $30 per prescription for eligible drugs in addition to normal reimbursements for drug costs and dispensing fees. After those two years, the fee would increase based on inflation. The legislation also imposes a $10,000 civil penalty per violation if a Medicare drug plan or Medicare Advantage Part D plan fails to pay the fee.The bill would also call for a study on the sustainability of LTC pharmacies under the new drug pricing schedule to create recommendations for longer-term payment systems that would preserve access, including in rural areas.

Call to Action

Several former and current legislators, as well as others, are calling on the Trump administration to act. The Preserving Patient Access to Long-Term Care Pharmacies Act was introduced by Senators James Lankford (R-OK) and Markwayne Mullin (R-OK). In a statement, Sen. Lankford said, “Seniors in long-term care facilities in Oklahoma and across the nation should never have to worry about access to the daily medicines they rely on. Long-term care pharmacies provide essential, specialized services, and it’s critical that we protect them and ensure they can remain in our communities. That’s why I’m proud to lead legislation that will keep long-term care pharmacies in operation and serving patients.”

Sen. Mullin added, “Long-term care pharmacies are essential to the health and safety of our seniors, especially in rural communities across Oklahoma. I’m proud to be working together on this necessary fix to ensure vulnerable seniors across our state receive the care they need without interruption.”

Writing for McKnight’s Long-Term Care News, Kimberly Marsela warned of “devastating consequences” if Congress doesn’t act. 

Without relief from Congress, the impact will grow when another 15 drug prices are lowered in 2027. The second-year drugs account for $1.52 billion of LTC pharmacy revenue in the analysis, versus $2.77 billion for the first-year drugs whose new prices go into effect Jan. 1.

The IRA authorized the price negotiations and ultimately resulted in capped payment formulas that subject LTC pharmacies to compensation far below current reimbursement levels.

Leaders at the Senior Care Pharmacy Coalition and the American Society of Consultant Pharmacists have previously told McKnight’s Long-Term Care News that LTC pharmacists deliver eight of the 10 drugs whose prices were negotiated in the first round. Dispensing those name-brand drugs has traditionally helped offset the government’s general preference for lower-cost generics in long-term care; the lower negotiated prices on expensive brand-name medicines undercut the delicate payment balance.

Alan Rosenbloom, president and CEO of SCPC said in a statement, “This new report confirms what we already know: LTC pharmacies and the patients they serve face devastating consequences in 2026 that will worsen appreciably in 2027 without immediate relief from policymakers in Washington.”

Republican State Rep. Cody Huneycutt (NC-67) also expressed his concerns about these changes in an op-ed for NC Political News.

Here’s why these matters: In North Carolina, over 160,000 beneficiaries of Medicare Part D have long-term care needs, meaning they live with chronic diseases or illnesses and can no longer fully care for themselves. These residents depend on the state’s 54 specialized LTC pharmacies to manage their complex medication regimens which can average 12-13 prescriptions daily per person.

Now, you might be thinking, “What’s the difference between these pharmacies and the one I go to?” It’s a fair question. Long-term care pharmacies are fundamentally different from the retail pharmacies most of us use. These pharmacies mainly serve nursing homes and assisted living facilities, providing round the clock emergency medication access. They deliver medications across long distances, manage specialized packaging, and handle the complex medical needs of long-term care patients. They also help nursing homes and assisted living facilities stay in compliance with federal law that requires these facilities to have pharmaceutical services.

…

That’s why we need immediate action—whether through legislation or administrative measures—to protect seniors’ access to the pharmacy care they depend on. I strongly support the Preserving Patient Access to Long-Term Care Pharmacies Act (H.R. 5031) as a critical step toward solving this problem.

Former Pennsylvania state lawmaker Will Tallman also called for action. In an op-ed in The Sentinel, Tallman wrote, “The damage will be felt everywhere, but the worse consequences will land squarely on rural Pennsylvania, where 11 out of the 72 LTC pharmacies are currently situated. If one pharmacy is forced to close, senior facilities will instantly lose the pharmaceutical services that are mandated by federal code. Without these services, these facilities cannot remain open. If these LTC pharmacies collapse, the senior homes they support will follow. And if those facilities close, rural families will have nowhere to turn.”

Writing for The Gazette in Iowa, former health care administrator Kelley Koch called on President Trump to “right Biden’s wrongs” on the issue.

“As a former health care administrator, I’m deeply concerned about an impending consequence brought on by Biden’s Inflation Reduction Act that threatens seniors in nursing homes and assisted living facilities,” Koch wrote. “Without these pharmacies, nursing homes may be unable to meet federal requirements and could be forced to close themselves, particularly in rural areas where a single pharmacy closure could impact multiple facilities serving our most vulnerable seniors.”

“Time is running out — Washington must act to protect our seniors,” Koch concluded.

Editor’s Note: Do you enjoy Townhall’s conservative reporting that takes on the radical left and woke media? Support our work so that we can continue to bring you the truth.

Join Townhall VIP and use the promo code FIGHT to get 60% off your VIP membership!