Medicare now pays pharmacists for routine care—if your state allows it.

What it does

This bill expands Medicare Part B coverage to pay pharmacists directly for certain clinical services—such as testing and treating COVID-19, flu, RSV, and strep throat—that they are legally authorized to perform under state law. Pharmacists would be paid at 80% of the lesser of actual charges or 85% of the physician fee schedule (100% for public health emergencies), and balance billing would be prohibited. The change takes effect January 1, 2026.

Why we flagged it

The bill's core function is to add a new category of covered services (pharmacist clinical services) to Medicare Part B and establish a payment mechanism. It is a straightforward coverage and payment amendment, not a deregulation, carve-out, or rider.

What the text implies

• State-law variation in pharmacist scope of practice may create geographic disparities in coverage; services legal in one state may not be covered in another, fragmenting the Medicare benefit.
• Payment at 85% of physician fee schedule (or 100% for public health emergencies) may incentivize pharmacists to classify routine services as public-health-emergency-related to capture higher reimbursement, creating moral hazard.
• Collaboration requirement with physicians or practitioners may be difficult to enforce or verify in real-time, potentially creating billing disputes and audit risk.
• No explicit cap on volume or frequency of pharmacist services; unbounded utilization could drive higher Medicare spending than projected, depending on uptake and state scope-of-practice rules.

Section numbers refer to the bill text the analysis read — linked under Primary records below.

Who it affects

Ordinary Medicare beneficiaries gain expanded access to pharmacist services at lower out-of-pocket cost (80% coverage, no balance billing), and pharmacists can provide routine acute-care services in underserved areas. The public health benefit is real—pharmacists are accessible, often in rural or underserved communities—though the financial impact on Medicare is not quantified in the text.

Who stands to gain

• pharmacists and pharmacy chains
• retail pharmacy networks
• pharmacy benefit managers (if they operate retail clinics)

Named in the bill

Medicare Part B, Social Security Act, Section 1861, Section 1833, Section 1842, pharmacists, physicians, practitioners, state law, Public Health Service Act, COVID-19, influenza — and 2 more

Where it stands

143 cosponsors: 80 Republicans, 63 Democrats.

• May 1, 2025 — Introduced · Congress.gov: “Introduced in House”
• May 1, 2025 — Referred to House Committee on Ways and Means and House Committee on Energy and Commerce · Congress.gov: “Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a…”
• May 21, 2026 — Markup held in committee · Congress.gov: “Committee Consideration and Mark-up Session Held”
• May 21, 2026 — Reported out of committee · Congress.gov: “Ordered to be Reported in the Nature of a Substitute by Voice Vote”

Dates and quoted wording are Congress.gov's action record; the timeline shows status changes, not every procedural step.

Money around this bill

46 lobbying clients named this bill on 59 disclosure filings across 3 quarters, Dec 2025 to Jun 2026. Those filings disclosed $29,441,194 in lobbying spend. A filing names 10 bills on average, so that figure is what each filing reported, not a share belonging to this bill.

More lobbying clients named this bill than 99% of bills with at least one filing.

Adrian Smith, the sponsor, reported $1,398,750 in PAC receipts in the 2026 cycle. $36,500 of that came from 8 PACs tied to these lobbying clients.

• Pharmaceutical Care Management Association — $6,472,656 on 2 filings
• American Medical Association — $5,643,000 on 2 filings
• CVS Health (and Subsidiaries) — $3,570,000 on 1 filing
• Walmart Inc — $2,060,000 on 1 filing
• Mckesson Corporation & Affiliates U.S. Oncology and Rx Savings Solutions — $1,710,000 on 2 filings

Lobbying Disclosure Act filings through Jul 20, 2026. A filing shows who paid to lobby on a bill it names, not what changed.