Long-term care (LTC) pharmacy is an unsung hero among the healthcare sector’s many players. But a critically important one for our loved ones in nursing homes and assisted living facilities across the country.
As more than 1,400 pharmacies care for millions of the nation’s most vulnerable patients, policymakers still struggle to understand the work they do and why it matters so much to long-term care residents and their families.
This disconnect, for newly appointed Senior Care Pharmacy Coalition (SCPC) President and CEO Esmé Grewal, may be the sector’s biggest challenge—and its biggest opportunity.
LTC pharmacies are specialized pharmacies that provide medications and clinical support services to patients living in skilled nursing facilities (SNFs), assisted living, nursing homes and other LTC settings.
Unlike traditional retail pharmacies, LTC pharmacies manage complex medication regimens for medically vulnerable populations, coordinating around the clock dispensing, delivery, medication management, consultant pharmacy services, and regulatory compliance for patients with chronic conditions and multiple prescriptions.
Ed Vess, Director of Pharmacy Professional Affairs at RedSail, sits down with Grewal to learn more.
Grewal steps into the position at a pivotal time.
Amid the rising tide of an aging baby boomer population, an influx of chronic disease, more complex options for pharmaceutical treatment and the corresponding demand for specialized medication management, and a growing rate of assisted living facilities across the country, LTC pharmacy is more critical than ever.
In fact, the U.S.’s long-term care population is expected to grow to 27 million people by 2050, up from about 7 million in 2020 according to the CDC.
At the same time, well-intentioned drug pricing reforms like the American Rescue Plan and the Inflation Reduction Act have inadvertently destabilized LTC pharmacy operations.
Because reimbursement has never reflected the cost of LTC services, many pharmacies face unsustainably shrinking margins when dispensing high-demand, high-cost medications.
Add in ongoing PBM pressures and a lack of consistent payment models for LTC pharmacies, and the industry is being asked to do more with less. Unfortunately, the outcome not only impacts LTC pharmacies, but also the nursing homes and assisted living facilities they serve, along with their residents.
For Grewal, the conflict is clear—but so is the solution. LTC pharmacy must be simplified and amplified in public policy.
Just this April, Esmé Grewal, J.D., was appointed the President and CEO of SCPC. A long-time pharmacy sector veteran, Grewal comes to SCPC with over 15 years of expertise in public policy.
An attorney by trade, she’s served in numerous roles in public health policy—including BrightSpring Health, where she worked on several important policy issues impacting long-term care pharmacy, including the Inflation Reduction Act and PBM reform.
She previously worked with the American Network of Community Options and Resources (ANCOR), where she represented providers of Medicaid services for people with intellectual and developmental disabilities; and the National Association of Councils on Developmental Disabilities (NACDD) where she served as a policy director.
As she led federal advocacy for improved Medicare and Medicaid policies, she worked closely with pharmacies and was increasingly exposed to the unique and specialized LTC pharmacy sector.
In the process, Grewal says, “I became particularly passionate about LTC pharmacy” by working with the “unsung heroes” of the healthcare system. As such, the transition to LTC pharmacy was "a natural fit" for Grewal.
SCPC is a nonprofit national trade association for LTC pharmacies that represents more than 300 members in Washington, D.C. Since 2014, SCPC has worked to ensure that lawmakers, regulators, and other administrative bodies understand “the distinct, essential role of LTC pharmacies.”
As Grewal describes, SCPC aims to be the “national voice” for all issues that impact LTC pharmacies.
As she takes up her new post, Grewal’s mission is to increase awareness of LTC pharmacy and make visible what’s for too long been invisible at the level of policy: the important work LTC pharmacies are doing to support their patients.
For Grewal, the core challenge facing LTC pharmacy is in its messaging.
“There is a deep desire to fix issues,” she explains, “but there’s also a deep void of understanding those issues, which prevents them from being fixed.”
On Capitol Hill, policymakers juggle competing issues that run the gamut from public health to social welfare to governmental spending. Add in the complexity of LTC itself—filled with PBMs, insurance plans, and regulatory requirements—and the waters can quickly become muddied.
When policymakers don’t understand what LTC pharmacies do, they can’t prioritize it. When they can’t prioritize it, they can’t implement policies to protect the critical services they provide.
As Grewal begins to lead the charge at SCPC her goal can be distilled into two ideas: simplify and amplify.
“Congress covers so many issues, and they have so little time to really download those issues,” she explains, “Our job is to simplify the message of long-term care pharmacy and amplify their story so policymakers understand what’s happening in their own backyard.”
That means translating the day-to-day realities of LTC pharmacy into clear, compelling narratives that policymakers can not only understand but can convert into measurable systemic policy changes with impact.
More importantly, it also means injecting industry-specific conversations into public discourse. Because until LTC pharmacy is understood across the entire healthcare landscape, it will continue to be devalued.
For Grewal, solving the visibility problem means ensuring that the work LTC pharmacies already do isn’t only recognized but supported and sustained.
If the first step is simplifying the message, the next is making sure that message reflects the full scope of what LTC pharmacies do.
For Grewal, one area stands out above the rest: medication management.
“If I were to pinpoint something that I really want to highlight in the next year for policymakers, it’s that the medication management piece is so significant,” she says.
For pharmacists, the correlation between good medication management and good outcomes is a no-brainer. A typical LTC patient relies on complex medication regimens—an estimated 12-13 per day—that requires constant oversight, coordination, and adjustment.
LTC pharmacies support patients across skilled nursing facilities (SNFs), assisted living facilities (ALFs), and home health settings, helping manage complex medication regimens, coordinate care transitions, and reduce avoidable hospitalizations..
When they’re managed well, these medications can avoid negative interactions, reduce hospitalization, lower healthcare spend, and improve quality of life for patients across the board.
But outside the industry, that connection isn’t always clear.
“Our communities benefit from what LTC pharmacies do there, but it’s not known. I want the public to know about the services that are happening behind closed doors, the outcomes that are coming from them, and the savings that the programs are experiencing.”
For Grewal, closing the gap starts by connecting daily pharmacy operations to real patient experiences, in short, telling the important story of what LTC pharmacies do everyday in communities across the country.
She goes on, “As humans, we can all relate to this. At some point, I bet you most people have had a loved one whose medication was not managed well. When you see it done well, it’s a phenomenal experience.”
For Grewal, the experience is personal. Growing up with two siblings with disabilities, she was inspired to pursue public policy to support groups making positive change, including LTC pharmacies.
“LTC pharmacists are the people that are changing lives and bringing relief and creating opportunities for people to live safely. You can’t put it into words what that means.”
For Grewal, pharmacists—LTC included—are the missing link in a complicated healthcare ecosystem that’s only growing more complicated. If we are to take care of the most vulnerable patient populations, then, we have to take care of LTC pharmacists.
Such is the work of SCPC.
Simplifying and amplifying is only effective when the right people hear it. For Grewal, that means being a “constant presence in D.C.”
“I believe that is so core to how our government works,” she says. “Showing up and making sure that they see you, know you’re a good partner, and making sure that your voice is very loud [is critical].”
As she steps into her role during a congressional election year—which is a traditionally quieter time for major legislation—Grewal sees an opportunity to reintroduce SCPC to policymakers, CMS leadership, and other committees of jurisdiction.
By putting SCPC at the forefront of legislation affecting LTC pharmacy, she aims to secure its place as a trusted voice.
Yet for Grewal, the voice of SCPC is strongest among its members. She advocates to bring SCPC’s 300 plus members to Capitol Hill so that “pharmacists’ voices are the ones being heard directly.”
This not only includes making policy changes but changing the perceptions of LTC pharmacy’s role in value-based care, home health services, and the question on every healthcare representative’s mind: how to care for the nation’s most vulnerable populations.
Grewal’s amplification, then, isn’t done only through diffuse policy work in congressional halls but in boots-on-the-ground grassroots advocacy among its members.
When policymakers meet pharmacists, hear their stories, and understand their challenges, real progress happens.
As Grewal looks to the future, she sees innovation as a key piece in solving LTC pharmacy’s visibility problem:
“LTC pharmacies have been around for a really long time and have done such a great job in our communities. They’ve been such a gift. Because they’ve been around so long, that means there’s a lot of great room for innovation: with artificial intelligence, telehealth, and more sophisticated data analytics.”
For her, innovation is key to understanding and understanding is key to change that will truly make a difference.
She says, “If the chief challenge is that most of the public and lawmakers don’t know about what [LTC pharmacists] do, then innovation could really spotlight what we do and set us up for the next level.”
Whether through better outcomes tracking, more integrated care models, or expanded services in home-based settings, these tools have the potential to translate LTC pharmacy’s day-to-day work into real results—and it’s those results that policymakers are looking for.
As Esmé Grewal says, LTC pharmacy is at a pivot point—and if we are to serve the nation in the coming decades, policy has to support the work that pharmacists are already doing and the work they’re going to do.
For Grewal, advocacy for the most vulnerable isn’t only the mission of her work but of her life: “It’s not only what gets me out of bed in the morning, but what keeps me working at night and on the weekends. It’s never truly work for me…. This is my life’s mission.”
Policy doesn’t change without advocacy, and organizations like SCPC and leaders like Grewal are on the frontlines of that advocacy. LTC pharmacies themselves can be, too.
“LTC pharmacies are rising. This is a historic time for the services that we offer. There’s no better time to be part of the association than now.”
Click to learn more about SCPC and how you can get involved.
