Ensuring Community Access to Pharmacist Services Act
Starting in January 2026, Medicare will cover visits to pharmacists for testing and treatment of illnesses such as COVID-19, the flu, RSV, and strep throat, as well as care during public health emergencies. Patients will be able to receive these services at pharmacies whenever state licensing laws permit it. To keep out-of-pocket costs predictable for patients, pharmacists will be barred from charging more than standard Medicare copayments.
What this bill touches.
Who it helps · who it burdens.
Who it helps
- PharmacistsGains direct Medicare Part B reimbursement for evaluation, testing, and treatment services for illnesses like COVID-19, flu, RSV, and strep throat, as well as declared public health emergencies, within their state scope of practice.
- Medicare beneficiariesGains Medicare Part B coverage for testing and treatment visits furnished by pharmacists for common respiratory illnesses and public health emergencies, protected from balance billing charges.
Who it burdens
- PharmacistsProhibited from balance billing Medicare beneficiaries, requiring them to accept Medicare payment terms and not charge patients amounts above standard Medicare cost-sharing.
Who backs it
- Medicare Part B programPays 80 percent of the allowable fee schedule rate for covered pharmacist evaluation and treatment services.
The provisions, in plain language.
Covers certain pharmacist services under Medicare Part B starting January 1, 2026, including patient visits for testing and treatment of COVID-19, flu, RSV, strep throat, and conditions related to declared public health emergencies, subject to state scope-of-practice laws.
Sets Medicare payments for covered pharmacist services starting January 1, 2026, at 80 percent of the lesser of the actual charge or 85 percent of the physician fee schedule amount, or 100 percent of the fee schedule amount for services addressing a declared public health emergency.
Prohibits pharmacists from balance billing Medicare patients starting January 1, 2026, requiring them to accept Medicare payment terms and not charge patients amounts above standard Medicare cost-sharing.