Medicare now pays pharmacists for routine care—if your state allows it.
H.R. 3164 — Ensuring Community Access to Pharmacist Services Act · Filed by Adrian Smith (R-NE) · 140 cosponsors · Introduced May 1, 2025 · Reported out
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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.
The full analysis lists 4 implications of this text.
Who stands to gain
pharmacists and pharmacy chains; retail pharmacy networks; pharmacy benefit managers (if they operate retail clinics)