Why is my pharmacy bill higher than when I lived at home?

This is a frequent question asked by long-term care (LTC) residents or their caregivers. To answer this, you must first understand the difference between LTC and retail pharmacies, such as CVS or Walgreens. LTC pharmacies are not open to the public. They contract with skilled and assisted living facilities to provide an all-encompassing pharmaceutical service. LTC pharmacies coordinate with the facility, provider, and payer to review and compare medications, meet rigorous packaging requirements, and provide delivery services 24 hours a day, seven days a week. Federal regulations require skilled nursing facilities to have consultant pharmacists provide medication and medical record reviews, not to mention numerous other services on site to ensure the facility is in compliance with all pharmaceutical requirements. All of this translates to a better standard of care for the residents but also a higher operating cost for the pharmacy.

Copay amounts charged for prescriptions by insurance companies are determined by the insurance plan and whether the insured received any government assistance (Medicaid). Another factor determining copay amounts is whether the pharmacy filling the medications is a ‘preferred’ or ‘in-network’ pharmacy. In many cases, especially with Medicare Part D plans, LTC pharmacies are not preferred and therefore the insured is charged slightly higher copays than a retail pharmacy that is in-network.

The bottom line is that LTC pharmacies provide numerous services to their contracted facilities and their residents. It is important to remember that when you have others administering medications to yourself or your loved ones, you want it to be as safe and accurate as possible. This is why LTC pharmacies exist!

Hope J. Hardy
Billing Manager
Holladay Healthcare Pharmacy

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