Long Term Care Guidance
March 16, 2005
This document is provided as guidance to assist Medicare Part D plans in formulating policies
for the implementation of CMS requirements regarding pharmacies providing products and
services to Long Term Care (LTC) facilities. This guidance is organized to address pharmacy
performance and service criteria, convenient access standards, formulary considerations, and
other beneficiary protections that Part D plans should consider as they develop their prescription
drug benefit offerings for institutionalized LTC Medicare beneficiaries. As defined by the final
regulation for the Medicare drug benefit, LTC facilities include skilled nursing facilities as
defined under Title XVIII of the Social Security Act (the Act), or a medical institution or nursing
facility for which Medicaid makes payment throughout a month as defined under Title XIX of
the Act.
I.
LTC Pharmacy Performance and Service Criteria
Part D plans will be required to offer a contract to any pharmacy willing to participate in its LTC
pharmacy network so long as the pharmacy is capable of meeting certain minimum performance
and service criteria (and relevant State laws governing the practice of pharmacy in the LTC
setting) and any other standard terms and conditions established by the plan for its network
pharmacies.
CMS has developed the following minimum performance and service criteria for pharmacies
providing LTC service, based on widely used best practices in the market today and with input
from various CMS divisions and external stakeholders. We expect that these performance and
service criteria will be incorporated into an addendum to a Plan’s standard network contract for
those pharmacies that would like to be designated LTC network pharmacies.
Performance and Service Criteria for Network LTC pharmacies (NLTCPs)
1. Comprehensive Inventory and Inventory Capacity -- NLTCPs must provide a
comprehensive inventory of Plan formulary drugs commonly used in the long term care