The bill expands Medicare-covered, pharmacist-delivered testing and limited treatment — improving timely access and reimbursing pharmacists — but increases Medicare spending while leaving narrow service scope and state-level rules that may limit or unevenly distribute those benefits.
Medicare beneficiaries will be able to receive outpatient testing and limited treatment for infectious diseases (COVID‑19, flu, RSV, strep) directly from pharmacists starting Jan 1, 2026, increasing timely access to care.
Pharmacists (and pharmacy providers) can bill Medicare for these covered services, creating a new revenue stream and incentivizing more pharmacies to offer timely testing and treatment.
During a declared §319 public health emergency, pharmacist-provided services are paid at a higher rate, encouraging surge capacity and greater provider availability in emergencies.
Taxpayers and the Medicare program will face increased spending to pay pharmacists for these services, raising program costs.
State supervision and collaboration requirements mean administrative complexity and could produce uneven access across states that have restrictive pharmacy practice laws, limiting benefits for beneficiaries in some areas.
Covered services are limited to a narrow set of infectious‑disease testing/treatment and §319 emergency responses, restricting pharmacists' ability to provide a broader range of reimbursed clinical care under Medicare.
Based on analysis of 2 sections of legislative text.
Adds limited pharmacist services to Medicare Part B for specified infectious testing/treatment, sets payment rules, and bans balance billing starting Jan 1, 2026.
Introduced May 1, 2025 by Adrian Smith · Last progress May 1, 2025
Adds a limited set of pharmacist-provided services to Medicare Part B so Medicare can pay for certain pharmacist testing and treatment for respiratory infections and for services tied to a declared public health emergency. It sets payment rules (generally 80% of a capped amount, 100% for declared public health emergencies), bans balance billing by pharmacists, and makes the changes effective January 1, 2026. The coverage is limited to services pharmacists are legally authorized to provide under state law and applies when services meet any applicable state supervision or collaboration requirements. The law focuses on testing/treatment for COVID-19, influenza, RSV, streptococcal pharyngitis, and other services tied to a Public Health Service Act §319 emergency.