Jesse Osmer

I’ve spent most of my career in public service, including time in both the United States and Michigan House of Representatives, City Council, and Board of Commissioners. Throughout these roles, one thing has been clear: when Washington policies overlook the realities of rural communities, rural communities are the ones who pay the price. In less than a month, changes to Medicare Part D reimbursement threaten to financially devastate long-term care pharmacies and the nursing homes and assisted living facilities they serve.

People with complex medical needs who can no longer care for themselves rely on long-term care services for both care and dignity. Long-term care (LTC) pharmacies provide federally required pharmaceutical services to nursing homes and assisted living facilities. These include 24/7 emergency services, medication delivery, and specialized packaging systems that help manage the 12-13 daily medications that LTC patients typically take. LTC pharmacies occupy a distinct role in the system of long-term care that your average retail pharmacy can’t cover.

In our congressional district, there are only seven LTC pharmacies, and none are in rural areas. Pharmacies from larger towns already drive hours to serve our facilities. If one LTC pharmacy closes, huge swaths of rural communities–including over 7,500 seniors with long-term care needs–could lose access to life-saving pharmaceutical care. For these seniors, many in their 80s and 90s, that means an impossible choice: relocate far from family and the communities they built or go without the medications that keep them alive.

The past administration’s ‘Inflation Reduction Act’ directed Medicare to negotiate lower prices on certain high-cost brand-name drugs. Making medications more affordable? That’s a good goal, and one I support.

But here’s the problem: the way Medicare now reimburses the pharmacies that serve nursing homes and assisted living facilities doesn’t account for how these businesses actually operate. LTC pharmacies run on razor-thin margins. They use the revenue from brand-name drugs to cover all the extras that make them different from your local pharmacy. Medicare says Part D plans must ensure access to LTC pharmacies, but it never bothered to fund that mandate. The payment structure doesn’t include separate reimbursement for delivery, specialized packaging, or any of the other services that define LTC care. So, these pharmacies have been doing what every rural provider does–making it work however they can and in this case, by relying on brand-name drug margins to stay solvent.

Cut the reimbursement rates on those brand-name drugs, and suddenly the math doesn’t work anymore. And here’s the kicker: eight of the ten drugs that Medicare just negotiated are among the most prescribed medications in nursing homes. The very facilities that depend most on these specialized pharmacies are about to watch them disappear. In Alpena County, where our median age is 20% higher than Michigan’s and 25% higher than the national average, this issue is especially urgent. It’s about whether our parents and grandparents can continue receiving care close to home or whether they’ll be forced to leave the communities they helped build.

As County Administrator, I know what it’s like to work within tight budget constraints. When I took this position, we faced a significant budget shortfall that forced impossible choices about priorities and resources. The board has had to say no to things that matter because the money wasn’t there.

There are solutions available, but time is running out. Both Congress and the White House can act to prevent this crisis before it begins. Congress can pass the bipartisan Preserving Patient Access to Long-Term Care Pharmacies Act (H.R. 5031), which would establish a supply fee for each prescription under the new negotiated prices. This fee would provide LTC pharmacies with the cushion they need to continue operations. The White House also has the authority to implement such a fee through the CMS, offering quick relief independent of congressional lengthy processes.

Seniors in rural communities deserve access to healthcare that allows them to stay in their communities and near the people they love. I urge Michigan’s congressional delegation to act swiftly before January 1st.

Jesse Osmer is a never-you-mind old political junkie who loves old movies, states’ rights, and well-made cocktails. He has worked as Political Director to former US Representative Dan Benishek MD, Legislative Director to former State Representative Sue Allor, and has served on both Alpena City Council and the Alpena County Board of Commissioners.