Regulatory and reimbursement changes are reshaping the long-term care (LTC) pharmacy landscape, and many of those changes are beginning to take effect now. In the latest episode of FrameworkFocus, host Todd Eury sits down with Dr. Dae Lee, Pharm.D., Esq., CPBS, Shareholder at Buchanan Ingersoll & Rooney PC, to break down how the Inflation Reduction Act (IRA) is moving from policy discussion to operational reality for pharmacies.
While the IRA has often been discussed in political terms, Dr. Lee explains that its real impact is far more practical for pharmacies navigating Medicare reimbursement.
“When people hear the Inflation Reduction Act, sometimes they think it’s a political talking point,” he said. “But what it actually did in healthcare is fundamentally restructure the Medicare Part D economics.”
One of the biggest shifts is the introduction of Medicare’s Maximum Fair Price (MFP) program, which allows Medicare to negotiate prices on certain high-cost drugs. The first negotiated prices will take effect in 2026, marking a significant change in how certain medications are reimbursed.
For LTC pharmacies, where high-volume chronic medications are dispensed under tight margins, these changes could introduce new financial pressure if reimbursement timing and acquisition costs don’t align. New payment processes, including the Medicare Transaction Facilitator, may also introduce additional complexity in how payments flow between manufacturers, plans, and pharmacies.
Beyond reimbursement mechanics, the changes also bring increased administrative responsibilities. Pharmacies may need to closely monitor which drugs are subject to negotiated pricing, track claims accurately, and ensure reimbursements align with evolving rules.
At the same time, Dr. Lee notes there are signs of momentum in Washington around broader pharmacy policy discussions.
“Right now, the pharmacy industry is filled with positive development,” he said. “For the past several years — or even a decade — pharmacy benefit managers have been really unfair toward independent pharmacies.”
“More legislators have been trying to make the playing field level and fair for the independent pharmacies out there.”
Still, the regulatory landscape continues to evolve, and pharmacies must remain vigilant as new policies are implemented and interpreted.
“We have to be vigilant to push back on any egregious practices that are going to be deployed by those PBMs,” Dr. Lee said.
For LTC pharmacy leaders, the message is clear: the IRA is not just a policy change — it represents a structural shift in how Medicare drug pricing and reimbursement will work going forward.
To hear Dr. Lee’s full insights on what these changes mean for LTC pharmacies and how organizations can prepare, listen to the latest episode of FrameworkFocus.
About Our Guest
Dr. Dae Lee, Pharm.D, Esq., CPBS
Shareholder - Buchanan Ingersoll & Rooney PC
Email: dae.lee@bipc.com
Dae Y. Lee is a pharmacist-attorney and Certified Pharmacy Benefits Specialist™ (CPBS™) who represents pharmacies, healthcare stakeholders, and plan sponsors in high-stakes disputes and regulatory matters involving Pharmacy Benefit Managers (PBMs) and government payors. Drawing on his dual training as a pharmacist and attorney, Dae focuses his practice on defending clients in audits, investigations, enforcement actions and complex reimbursement and compliance matters.
Dae routinely represents pharmacies nationwide in PBM and payor audits, including Fraud, Waste and Abuse (FWA) investigations, extrapolation disputes, overpayment recoupments, credentialing denials, network suspensions and terminations. He advises pharmacies on compliance with applicable state pharmacy fair audit laws, PBM provider manuals, and reimbursement standards, with the goal of minimizing financial exposure while preserving network participation and business continuity.
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FrameworkFocus is focused exclusively on Long-Term Care Pharmacy. We release a new episode every month that addresses the hottest topics in LTC pharmacy through timely interviews with industry trailblazers, thought leaders, and LTC pharmacists. Follow and subscribe to the podcast wherever you listen so you do not miss an upcoming episode.
