This bill would expand Medicare Part B to cover pharmacist-provided services. It creates a new, defined category of pharmacist services and allows payment for these services when performed under state-law supervision or collaboration with a physician.
It also sets a Medicare payment rate for pharmacist services and prohibits balance billing for these services. The changes would take effect for items and services furnished on or after January 1, 2026.
At a Glance
What It Does
Adds pharmacist services to Medicare Part B coverage and defines what counts as pharmacist services, including collaboration with physicians and certain testing/treatment activities.
Who It Affects
Medicare beneficiaries who receive pharmacist-driven care, community pharmacies, and clinicians who collaborate with pharmacists.
Why It Matters
Sets parity for pharmacist-delivered care within Medicare, potential access gains in community settings, and a framework for pharmacist-led testing and management during public health needs.
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What This Bill Actually Does
The Equitable Community Access to Pharmacist Services Act would extend Medicare Part B to pay for pharmacist-provided care. It defines 'pharmacist services' as services and supplies provided by a pharmacist under state law, either directly or as an incident to the pharmacist’s service, and performed under supervision or in collaboration with a physician or other qualified practitioner.
The bill specifies that such services can include evaluation and management visits for testing or treatment related to COVID-19, influenza, RSV, streptococcal pharyngitis, or other public health needs during a declared public health emergency. The relationship between pharmacists and physicians—described as collaboration—would be governed by jointly developed guidelines or state-law mechanisms, ensuring appropriate medical direction and supervision.
On payment, Medicare would cover pharmacist services at 80% of the lesser of the actual charge or 85% of the payment basis determined under the physician-fee schedule (1848), with 100% applicable when the service addresses a defined public health need. The bill also prohibits balance billing for pharmacist services.
The changes would apply to items and services furnished on or after January 1, 2026.
The Five Things You Need to Know
Adds pharmacist services to Medicare Part B coverage.
Defines pharmacist services and collaboration under state law.
Sets payment as 80% of lesser of charge or 85% (100% for certain public health needs) of the 1848 basis.
Prohibits balance billing for pharmacist services.
Applies to services furnished on or after January 1, 2026.
Section-by-Section Breakdown
Every bill we cover gets an analysis of its key sections.
Short title
Section 1 designates the act as the Equitable Community Access to Pharmacist Services Act. This short title frames the bill’s overall aim: to formalize pharmacist-provided care within Medicare and set the terms of coverage and payment.
Coverage of pharmacist services under Part B
Section 2(a)(1) amends Section 1861 to include ‘pharmacist services’ (KK) as a covered item under Medicare Part B. This creates the statutory basis for payment of pharmacist-provided care when the services are legally permissible under state law and performed under the appropriate supervision or collaboration with a physician or practitioner.
Definition of pharmacist services and collaboration
Section 2(a)(2) adds the definition of ‘pharmacist services’ to the statute. It covers services performed by a pharmacist and any supplies incident to those services when allowed by state law and when the services would be covered if provided by a physician or as an incidental to a physician’s service. It also specifies such services may include those for COVID-19, influenza, RSV, or streptococcal pharyngitis, as well as public health needs during a public health emergency, and introduces a formal notion of ‘collaboration’ with a physician or practitioner.
Payment framework for pharmacist services
Section 2(b) revises payment under Section 1833(a)(1). It strikes the prior clause and inserts a new provision: the amounts paid for pharmacist services shall be 80% of the lesser of the actual charge or 85% of the amount determined under the 1848 payment basis (with 100% in cases addressing a public health need). This creates a dedicated payment framework aligned with physician-payment schedules, but tailored to pharmacist-provided services.
Prohibition on balance billing
Section 2(c) extends the balance-billing prohibition to pharmacist services. Amendments to Section 1842(b)(18) ensure that patients are not billed beyond the Medicare payment for pharmacist services in situations where a pharmacist provides covered care in collaboration with a physician.
Effective date
Section 2(d) provides that the amendments apply to items and services furnished on or after January 1, 2026, establishing a clear implementation date for coverage, payment, and anti-balance-billing provisions.
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Explore Healthcare in Codify Search →Who Benefits and Who Bears the Cost
Every bill creates winners and losers. Here's who stands to gain and who bears the cost.
Who Benefits
- Medicare beneficiaries who receive pharmacist-delivered care in community and clinic settings, gaining greater access and convenience.
- Community pharmacists and pharmacies, which can bill Part B for certain pharmacist services and expand service lines.
- Physicians and other practitioners collaborating with pharmacists, via defined collaboration arrangements that support team-based care.
Who Bears the Cost
- Medicare program funding, as it increases coverage and payment for pharmacist services.
- Pharmacists and pharmacies, which may incur costs to implement supervision/collaboration arrangements and to meet new documentation standards.
- Physician practices and clinicians who must participate in collaborative arrangements, potentially increasing time and administrative overhead to support pharmacist services.
Key Issues
The Core Tension
The central tension is between expanding access to pharmacist-provided care (and potentially improving public health responsiveness) and the need to control Medicare costs and ensure consistent practice standards across states with varying scope-of-practice laws.
The bill’s design aims to balance access with cost and quality controls. By tying pharmacist services to state-law scopes of practice and requiring supervision or collaboration, it preserves safeguards around medical direction.
However, the expansion raises questions about uniformity across states, the sufficiency of collaboration guidelines, and the administrative burden on providers and CMS to process added payments and monitor utilization. The public health emergency carve-out—permitting higher payment or broader service eligibility—could drive demand for pharmacist-led testing and management, but also heightens the risk of uneven implementation if state rules vary.
Data on utilization, outcomes, and cost impact will be critical for assessing effectiveness once implemented.
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