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Expanding long-term care pharmacy in home and community-based settings: understanding and addressing the barriers 


LTC pharmacy includes high-touch coordination, patient and caregiver education supports, and other services important to individuals with functional and cognitive frailty. However, existing policies have created operational barriers to providing LTC pharmacy services to individuals living at home or in the community.


In partnership with the Senior Care Pharmacy Coalition (SCPC), ATI Advisory interviewed industry experts and analyzed policies affecting LTC pharmacies. The analysis found that the lack of understanding around what LTC pharmacy offers stems from policies that are unclear or non-existent, and this results in Part D Plans (PDPs) and Pharmacy Benefit Managers (PBMs) not reimbursing for LTC pharmacy services outside the facility setting.


Individuals choosing to age in place should have access to necessary supports. While facility-based care is an essential part of the long-term care continuum for individuals with complex needs, the policy environment should not default to only covering services for individuals once they become long-term care facility residents. Policymakers should clarify that an individual’s level of need, not their residence, determines access and eligibility for LTC pharmacy services.

For previous SCPC/ATI research profiling Medicare beneficiaries with long-term care needs, see this report.


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