#United States #Long-Term Care #Parsippany #Express Scripts #Managed Health Care

Collaboration to Enhance Reimbursement Value for Long-Term Care Pharmacies

On January 21, 2026, Managed Health Care Associates, Inc. (MHA) announced a new collaboration with Express Scripts, marking a significant advancement in reimbursement strategies for long-term care pharmacies in the United States. This partnership aims to address the ongoing financial challenges these pharmacies face, especially amidst the evolving healthcare landscape characterized by rising operational costs and new regulatory frameworks.

Background of the Collaboration

MHA, recognized as the nation's foremost post-acute group purchasing organization, has been instrumental in supporting healthcare providers with efficient purchasing and pharmacy services. The organization previously established a three-year contractual relationship with Express Scripts, a renowned national provider of pharmacy benefit services. Building on this foundation, the two organizations have committed to enhancing their cooperation to offer a new reimbursement model that aligns with recent legislative changes, notably the Inflation Reduction Act (IRA) and its Maximum Fair Price (MFP) medication reimbursement pathways.

Key Objectives of the Agreement

The core intent of this collaboration is to implement an improved reimbursement framework that seeks to deliver tangible benefits to LTC pharmacies, ensuring a sustainable business environment while enhancing patient care. Some of the anticipated benefits for MHA member LTC pharmacies include:

• - Greater Predictability and Transparency: The new model aims to stabilize reimbursement rates and provide clearer guidelines for pharmacies, enabling them to better manage their financial resources.
• - Increased Business Stability: By creating a more predictable reimbursement process, LTC pharmacies can invest in better services and technologies, thus improving future growth potentials.
• - Tailored Considerations for Diverse Care Settings: The enhanced model recognizes the varying needs of different care environments, allowing for customization that reflects the unique challenges faced by LTC facilities.
• - Emphasis on Patient Health Outcomes: The collaboration will channel resources into improving patient health results, aligning financial incentives with quality of care objectives as outlined by both the Centers for Medicare & Medicaid Services (CMS) and plan sponsors.

Statements from Key Representatives

Russell Procopio, Executive Vice President and Head of Revenue & Commercial at MHA, expressed optimism about this partnership: “Building on our recent three-year agreement with Express Scripts, this enhancement will represent a meaningful step forward for LTC pharmacy reimbursement.” Procopio underscored the strength of the relationship between MHA and Express Scripts, stating that this commitment to innovation and adaptability is timely, especially as member pharmacies navigate the complexities of modern healthcare.

Challenges Faced by LTC Pharmacies

Long-term care pharmacies play a crucial role in managing the health of some of the most vulnerable patient populations, yet they often operate under strict financial constraints. The need for effective medication management and patient support is heightened in these settings, and the financial viability of LTC pharmacies is under continuous threat from evolving regulations and market pressures. By enhancing reimbursement models, MHA and Express Scripts aim to alleviate some of these pressures and empower pharmacies to provide better care to their patients.

Looking Ahead

The introduction of this new reimbursement model is expected later this year, providing a timely boost for LTC pharmacies as they continue to confront the challenges of an increasing demand for services. With MHA and Express Scripts working together, there is hope for a significant transformation within the LTC pharmacy sector that prioritizes patient care while fostering economic sustainability. As the healthcare industry evolves, partnerships like this will be critical in ensuring that pharmacies can sustain high-quality patient services in the face of ongoing challenges.

About MHA

Managed Health Care Associates, Inc. is dedicated to supporting alternate-site healthcare providers through an extensive portfolio of services, including managed care contracting and specialty pharmacy solutions. The organization’s commitment to innovation in healthcare delivery continues to drive growth and improved patient outcomes across the sector. For more information, visit www.mhainc.com.