Before We Leap: Questions About Maine's Pharmacy Crisis and Our Path Forward
The Press Herald opinion piece this week about Maine's impending long-term care pharmacy crisis raises urgent concerns for 22,092 seniors who depend on these services. Rep. Robert Foley is right that changes to Medicare Part D reimbursements taking effect January 1st could devastate long-term care pharmacy providers like Bedard in Auburn and many others across our state. I agree we need to protect these pharmacy services and the assisted living facilities that depend on them.
But agreement on the problem doesn't mean we should rush into solutions without asking the right questions first.
The On-Site Pharmacy Idea: Promising, But Let's Do Our Homework
I'm not opposed to facilities hosting their own pharmacies. In fact, there's something appealingly straightforward about it. When I was a kid, you could get your prescription filled right at the doctor's office at the end of your appointment. Simple. Efficient. Done.
But before we advocate for assisted living facilities to take this on, we need to understand what we're actually asking of them.
Here's what I'd want to know first:
How many older adults in a typical facility are on the same types of medications? If we're talking about a facility where 80% of residents take similar medications for common conditions—blood pressure, cholesterol, diabetes management—then an on-site dispensary starts to make sense. The burden becomes manageable. The tasks become repetitive in a good way. You're not asking staff to become experts in hundreds of different medications; you're asking them to become very good at managing perhaps two dozen common prescriptions.
But if every resident has a unique medication profile with complex interactions, if we're asking facilities to stock and manage hundreds of different medications, if we're requiring staff to develop expertise far beyond their current training—then we're not simplifying anything. We're creating a new burden that could overwhelm the very facilities we're trying to protect.
The critical question isn't "can facilities do this?" It's "should they?"
To have a dispensary in a facility means people must be familiar with what they're dispensing. That's not negotiable. We cannot ask facilities to take on pharmaceutical responsibilities without ensuring they have the capacity, training, and systems to do it safely. The last thing we need is to solve a pharmacy access crisis by creating a medication safety crisis.
Can We Please Acknowledge the Broader Field?
This line from the opinion piece stopped me cold: "Nobody has fought harder for Maine seniors and rural communities than Susan Collins."
Look, I'm not here to diminish Senator Collins' work on these issues nationally. She has done important work. But this kind of statement reveals something deeply problematic about how we discuss aging issues in Maine: we treat it like there's one hero working alone instead of recognizing the ecosystem of people who have dedicated their careers to this work.
Let me be clear: Even if you don't want to acknowledge the level of work I've put into getting this field the attention it deserves over the last five years, at least acknowledge the Executive Director of the Maine Council on Aging. At least acknowledge the nurses unions who see these medication management challenges daily on the floor. At least acknowledge the advocates who worked on the Blueprint for Action on Healthy Aging. At least acknowledge the municipal leaders who convened task forces. At least acknowledge Governor Mills, who—whether or not you agree with her approach—has been asking questions about how different parts of our aging infrastructure fit together for at least seven years.
I met Governor Mills once. She asked me how the Wasileski family and their 55+ communities fit into Maine's aging landscape. That wasn't a throwaway question. That was someone trying to understand the whole picture. I don't think those questions stopped. I think the full picture just never came together clearly enough for anyone to see it.
And that's the real problem.
The Fragmentation Problem
This pharmacy crisis isn't happening in isolation. It's one piece of a fragmented system where different parts barely talk to each other:
Long-term care facilities operate under one set of rules and funding mechanisms
Residential care facilities operate under different, looser standards
55+ communities exist in yet another category
Home care operates independently
Pharmacies are struggling with reimbursement changes
Each crisis gets addressed as if it's separate. Each solution gets proposed by different advocates who may not even know about each other's work. We write opinion pieces that credit single heroes instead of building collaborative infrastructure.
Unless we define some roles and create real coordination, we cannot move forward effectively.
What Needs to Happen
Before we can solve the pharmacy crisis—or any of the other crises facing Maine's aging population—we need to do something uncomfortable: we need to acknowledge that no single person, no single legislator, and no single solution will fix this.
We need:
1. Real data on medication patterns - Before advocating for on-site pharmacies, let's understand what we're actually asking facilities to manage. Senior Care Pharmacy Coalition in Washington, D.C. appears to scratch the surface of the discussion.
2. Honest assessment of facility capacity - Can facilities handle this responsibility without it becoming overwhelming? What support would they need?
3. Coordination across the field - Advocacy organizations like the Maine Council on Aging, nurses unions, legislative leaders, facility operators, and state agencies need to be working from the same playbook. No single organization has all the answers or should be treated as the sole voice for this work.
4. Recognition of existing work - Stop treating aging advocacy like it's one person's heroic effort. It's a field. It's a community. It's decades of accumulated expertise.
5. Clear role definition - Who is responsible for what? How do different parts of the system connect? Where are the gaps?
Moving Forward
The pharmacy crisis is real and urgent. The January 1st deadline is real. We absolutely need to protect our facilities and the seniors who depend on them.
But urgency shouldn't mean we leap without looking. The best solutions will come from understanding the full complexity of what we're dealing with and building on the collective wisdom of everyone who's been working on these issues—not just the people who get quoted in the Press Herald.
Every Saturday, I sit down to write about these issues because they matter. Because the field matters. Because 22,092 seniors deserve better than fragmented solutions from isolated heroes.
They deserve a system that actually works together.
What are your thoughts on on-site pharmacy facilities? What questions should we be asking? Leave a comment below or reach out directly.
