Community Pharmacists Fill Long-Term Care Gaps

Long-term care (LTC) pharmacy has operated for decades just out of public view, packaging and delivering medications to the nation’s nursing homes, assisted living facilities, group homes, and other residential settings. Now, reimbursement changes tied to the Inflation Reduction Act (IRA) of 2022 are threatening to unravel that infrastructure just as the aging population it serves continues to grow. According to a survey released in December 2025 by the American Society of Consultant Pharmacists (ASCP) and the Senior Care Pharmacy Coalition (SCPC), more than 80% of responding LTC pharmacies expect to reduce services in 2026, a shift that could affect more than 1.6 million vulnerable older adults nationwide.¹

For community and independent pharmacists, many of whom already serve overlapping populations of older, medically complex patients, the unfolding crisis raises a pointed question: What role can pharmacy practice outside the closed-door LTC model play in closing the gap?

Behind the Curtain of LTC Pharmacy

LTC pharmacies are unlike the retail pharmacies most patients visit on a street corner. They are not open to the public, are often housed in unmarked business parks, and operate as large-scale, closed-door dispensing and packaging operations, according to Esmé Grewal, JD, president and CEO of SCPC. Rather than filling a single prescription for a walk-in customer, LTC pharmacies build a packaged medication regimen for each resident of a facility, subject the order to multiple layers of review, and hand-deliver it by courier, sometimes multiple times a day.²

The sector predates Medicare Part D, having served the Medicaid program before being pulled into Part D in the early 2000s, and it still relies on Part D for roughly 75% to more than 80% of its revenue, a far heavier concentration than retail pharmacy sees. LTC pharmacies also employ LTC consultant pharmacists, who go into facilities to review residents’ drug regimens directly with patients and families, screen for unsafe interactions, and lead deprescribing efforts for a population that is often taking a dozen or more medications and sometimes 20 or more immediately after a hospital stay.^1,2

“LTC pharmacists are going into the facilities and are meeting with the patients, with their families, and reviewing the drug regimen that the individual’s on,” Grewal told Drug Topics.² “Something that I really think needs to be looked at is how the role of LTC pharmacists can be heightened and then also applied in other parts of our health sector because I really think it’s just a phenomenal role that we offer.”

The stakes of that medication management are considerable. General medication adherence across the population hovers around 50%, and 20% to 33% of preventable emergency department visits among Medicare patients are medication-related, according to figures Grewal cited from a Department of Health and Human Services (HHS) briefing.²

By contrast, LTC pharmacy services are associated with 92.5% adherence in nursing homes and 85.5% adherence in assisted living settings, and a study applying LTC pharmacy principles in patients’ homes found a 73.1% reduction in hospitalizations. Nationally, nonoptimized medication therapy is estimated to cost $528 billion annually in avoidable spending, or 16% of total health expenditures.²

A Reimbursement Crisis With Rural Consequences

That infrastructure is now under acute financial pressure. The ASCP/SCPC survey, whose respondents represent roughly 20% of the nation’s estimated 1400 closed-door LTC pharmacies and serve more than 800,000 patients, found that 84% plan to reduce services or exit certain facilities or regions entirely, and 78% plan to lay off staff, with layoffs already underway. Nearly 300,000 of the patients served by survey respondents live in rural communities, where access to alternative pharmacies is often limited.¹

“We are witnessing the collapse of America’s [LTC] pharmacy infrastructure in real time, led by small, independent LTC pharmacies throughout the country,” Alan Rosenbloom, president and CEO of SCPC, said in the news release about the survey.¹ “These aren’t projections—these are decisions LTC pharmacies are making right now because small and midsize LTC pharmacies cannot survive under the current reimbursement structure. When these pharmacies close, there is no one to replace them.”

The immediate driver is a change to how Medicare Part D plans reimburse LTC pharmacies for brand-name drugs subject to negotiated prices under the IRA, which took effect January 1, 2026. LTC pharmacies have historically relied on higher brand-name reimbursement to offset inadequate generic reimbursement and underpayment for legally required LTC services. Lower negotiated-price reimbursement removes that offset for drugs heavily prescribed to LTC patients.¹

“Rural America will be hit hardest,” said Chad Worz, CEO of ASCP.¹ “Nearly half of the LTC pharmacies surveyed serve rural communities—areas already struggling with health care access. When these pharmacies reduce services or can no longer survive serving rural nursing homes, where will those homes and their patients turn?”

SCPC has pointed to the Preserving Patient Access to Long-Term Care Pharmacies Act (H.R. 5031 and S. 3159) as a targeted fix that would establish a temporary supply fee for negotiated-price medications dispensed by LTC pharmacies. Grewal noted that the sector’s core policy challenge has long been a lack of recognition. For years, SCPC pursued a statutory definition of LTC pharmacy to prevent it from being swept into regulations, including those from the Drug Enforcement Administration, that were not designed with LTC pharmacy in mind.^1,2

Community Pharmacies Testing a New Model

Worz’s question about where rural nursing homes and their patients will turn points to one possible answer already being tested: community pharmacy. According to the HHS, 7 in 10 adults reaching age 65 years are expected to need some form of LTC before the end of their life, and by 2030, an estimated 24 million Americans will need it, yet fewer than 5% of home health agencies have a pharmacy affiliation. That gap has left many older adults without professional medication management support at home, a lack of coordination that researchers cite as a driver of unnecessary transitions into facility-based care.³

A pilot study published in Innovations in Pharmacy describes one rural, independent community pharmacy’s attempt to close that gap by building its own long-term care at home (Home LTC) service, delivered in part through a community health worker who also served as a pharmacy technician. The service combined comprehensive medication reviews, medication synchronization, adherence packaging, and as-needed home visits for clinical interventions such as immunizations and blood pressure checks.³

Fourteen patients were enrolled, with an average age of 61 years, 13 current medications, and 4 chronic conditions. Every enrolled patient received at least 1 clinical intervention, most commonly an immunization review as well as in-home vaccinations, a blood pressure monitor with instruction, a switch in urinary tract infection prophylaxis, and continuous glucose monitoring and insulin administration education. Half of enrolled patients or their caregivers completed a follow-up satisfaction survey, and all reported being “extremely satisfied” with the services received, with one exception reporting “somewhat satisfied” with delivery.³

Billing, however, proved to be the project’s greatest limitation. Despite submitting claims using the designated LTC-at-home billing codes, the pharmacy secured additional reimbursement for only 8 of the 14 patients, and even then, the increase did not cover the added cost of packaging and staff time. The study’s authors point to a 2021 evaluation of the national ExactCare Home LTC program as evidence of what’s possible at scale, which was that the commercial program was associated with increased adherence to statin and antihypertensive therapy, fewer and shorter skilled nursing facility admissions, and an estimated $2400 reduction per member per year in total cost of care.³

A separate randomized trial of home-delivered pill packs in a low-income, state-insured population found a missed-dose rate of 3.7% in the intervention group compared with 17.4% in the control group, and a systematic review of 52 adherence-packaging studies found packaging associated with an improvement in adherence of up to 8 percentage points.³

Building the Evidence Base for Pharmacist-Led Geriatric Care

The rural pilot’s findings fit into a broader and growing body of literature on pharmacists’ roles in geriatric care. A narrative review published in Aging Clinical and Experimental Research synthesized 32 randomized controlled trials and systematic reviews published from 2014 to 2024, spanning home, community, outpatient, hospital, and LTC settings. Nearly 72% of the included studies reported positive outcomes from pharmacist-led interventions, most often centered on medication appropriateness, deprescribing, medication safety, and treatment effectiveness.⁴

The review authors describe community pharmacists as among the most accessible health care professionals for older adults and their caregivers and note that pharmacist-led medication reviews conducted through community pharmacies have been linked to reduced drug-related problems and improved adherence in several countries, including Australia, New Zealand, and the Netherlands.⁴

Within nursing home and residential care settings specifically, the same review points to evidence that pharmacist involvement reduced the mean number of falls, lowered residents’ overall medication burden, and was linked to modest cost savings, even as some outcomes, including hospitalization and mortality, showed mixed results across studies. A separate meta-analysis of medication adherence interventions cited in the review found that pharmacist-led approaches produced a moderate improvement in adherence among older adults, with the strongest effects seen when education was individualized and delivered in patients’ homes or across multiple care settings, though the benefit tended to diminish over longer follow-up periods.⁴

A Case for Elevating the Role

Grewal, for her part, argues that the solution to LTC pharmacy’s overlooked status is not retrenchment but recognition, both for the closed-door LTC sector and for the broader pharmacy workforce that shares its patient population.

“My main hope is that [LTC] pharmacies are no longer health care’s best-kept secret,” she said, describing a vision in which LTC pharmacy is treated as “a before thought, not an afterthought” in health policy.²

For community and independent pharmacists, the current moment presents both a warning and an opening. The reimbursement pressures squeezing closed-door LTC pharmacies, particularly small and rural operators, are a direct consequence of policy built around Part D economics that did not anticipate the sector’s unique cost structure.¹

Community pharmacies exploring their own Home LTC services face a similar reimbursement mismatch, as the Iowa pilot study illustrates. But the underlying clinical case, that pharmacist-led medication review, deprescribing, and adherence support measurably improve outcomes for older adults, is well documented across both settings. Whether policy makers extend that recognition to community and independent pharmacists taking on LTC-style services, much as SCPC is asking them to do for the LTC sector itself, may determine how much of the coming gap gets filled.^3,4

REFERENCES

1. New survey reveals imminent long-term care crisis: 80% of America’s nursing home residents face loss of access to essential prescription drugs pharmacy services in 2026. News release. Senior Care Pharmacy Coalition. December 30, 2025. Accessed July 10, 2026. https://seniorcarepharmacies.org/new-survey-reveals-imminent-long-term-care-crisis-80-of-americas-nursing-home-residents-face-loss-of-access-to-essential-prescription-drugs-pharmacy-services-in-2026/

2. Nowosielski B, Grewal E. Why LTC pharmacy is health care’s most overlooked, undervalued sector. Drug Topics. July 9, 2026. Accessed July 10, 2026. https://www.drugtopics.com/view/why-ltc-pharmacy-is-health-cares-most-overlooked-sector

3. Ditzman M, Veach S, Schaefer J, Luett K, Kendall B, Witry M. Implementation and evaluation of a long term care at home (Home LTC) service in a rural community pharmacy setting. Innov Pharm. 2025;16(1). doi:10.24926/iip.v16i1.6469

4. Harasani K, Duque S, Piotrowicz K, et al. The role of pharmacists in geriatric care: current evidence and practice. Aging Clin Exp Res. 2026;38(1):21. doi:10.1007/s40520-025-03254-7