Ensuring Community Access to Pharmacist Services Act

Summary

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.

• Medicare Part B will cover certain pharmacist-provided testing and treatment services starting January 1, 2026.
• Covered services are limited to E/M visits for COVID-19, influenza, RSV, and strep throat, plus services tied to a declared §319 public health emergency.
• Payment is set at 80% of the lesser of the actual charge or 85% of the physician fee schedule amount; 100% of that capped amount in a §319 emergency.
• Pharmacist services are covered only if the pharmacist is legally authorized by state law and follows any state supervision/collaboration rules.
• Balance billing for covered pharmacist services is prohibited, protecting Medicare beneficiaries from surprise charges.
• This does not grant full provider status for all pharmacist services—coverage is narrow and condition-specific.
• Implementation will require Medicare administrative actions (coding, billing guidance, fee calculations) before the effective date.
• May improve access to testing and short-course treatment in community pharmacies, especially during outbreaks or declared emergencies.