Summary

Adds pharmacist services to Medicare Part B so Medicare will cover certain services provided by pharmacists beginning January 1, 2026. Coverage is limited to services allowed by state law (including any required physician supervision or collaboration), specific visit types (including some testing and treatment for listed respiratory illnesses and services tied to declared public health emergencies), and explicitly bans balance billing for those pharmacist services.

Key Points

• Medicare Part B will cover defined pharmacist services starting January 1, 2026.
• Coverage is allowed only where state law permits pharmacists to provide the service, including any required supervision or collaboration.
• Covered pharmacist visits are limited to specific visit types (e.g., certain respiratory testing/treatment and public health emergency services).
• Balance billing for covered pharmacist services is prohibited for Medicare beneficiaries.
• CMS will need to establish billing codes, payment rules, and enrollment processes for pharmacists to bill Medicare.
• Access gains for Medicare beneficiaries will vary by state because of differing pharmacist scope-of-practice laws.
• The change is targeted rather than a broad expansion of pharmacist provider status under Medicare.

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