Equitable Community Access to Pharmacist Services Act
The Equitable Community Access to Pharmacist Services Act would expand Medicare Part B coverage to include pharmacist-provided services. It defines pharmacist services as those performed by a pharmacist (and certain supplies furnished as an incident to the pharmacist’s service) that a pharmacist is legally allowed to perform under state law, and that would otherwise be covered if provided by a physician or as an incident to a physician’s service, if these services are provided under the supervision or collaboration required by state law. Specifically, it covers visits for evaluation and management related to testing or treatment for COVID-19, influenza, RSV, or streptococcal pharyngitis, or testing/treatment addressing a public health need during a public health emergency. The bill also sets payment rules (Medicare would pay 80% of the lesser of the actual charge or 85% of the standard payment rate for such services, with 100% in certain public health emergency cases) and prohibits balance billing for pharmacist services. The changes would take effect for services furnished on or after January 1, 2026. In short, the bill would help pharmacists bill Medicare directly for certain clinical services they provide, require collaboration with physicians where state law requires it, and aim to improve access to care (especially for certain infectious diseases and public health emergencies) while preventing patients from receiving surprise bills for these services.
Key Points
- 1Coverage expansion under Medicare Part B: Pharmacist services, including services performed by a pharmacist and certain related supplies, would be eligible for Part B payment when performed under supervision or collaboration with a physician or practitioner as required by state law.
- 2Scope of services: Coverage includes visits for evaluation and management related to testing or treatment for COVID-19, influenza, RSV, or streptococcal pharyngitis, and testing/treatment addressing public health needs during a declared public health emergency.
- 3Collaboration requirement: Pharmacist services must be delivered in collaboration with a physician or practitioner, with medical direction and supervision as defined by jointly developed guidelines or state-law mechanisms.
- 4Payment structure: Medicare would pay 80% of the lesser of the actual charge or 85% (or 100% for certain public health emergency-related services) of the payment amount determined under the standard payment basis for those services (as outlined by the 1848-based rate structure).
- 5Prohibition on balance billing: Patients would be protected from balance billing for pharmacist services, aligning payer payments with limits on patient charges.
- 6Effective date: The amendments apply to items and services furnished on or after January 1, 2026.