Medicare expands coverage to pharmacists in underserved areas

What it does

This bill expands Medicare coverage to include pharmacist services performed in medically underserved areas, allowing pharmacists to bill Medicare directly for services they are legally authorized to perform under state law and that would otherwise be covered if a physician provided them. Medicare would pay pharmacists 80% of the lesser of actual charge or 85% of the physician fee-schedule amount, effective January 1, 2027.

Why we flagged it

The bill's sole operative mechanism is to add a new category of covered services (pharmacist services) to Medicare's benefit package, conditioned on geographic and state-law constraints. This is straightforward healthcare coverage policy, not a tax provision, appropriation, or regulatory carve-out.

What the text implies

• Pharmacist scope of practice varies significantly by state; coverage is limited to services 'legally authorized' under state law, meaning some states' pharmacists may offer fewer billable services than others, creating geographic inequity within the underserved-area framework.
• Payment at 85% of physician fee-schedule amount may incentivize pharmacists to perform services at the margin of their legal scope in states with broader authorization, potentially shifting care patterns away from physicians in shortage areas.
• The bill requires HHS to develop 'pharmacist specific codes' under the physician fee schedule, but does not specify whether these codes will be granular enough to distinguish between different pharmacist services or will be bundled, affecting billing accuracy and fraud detection.

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

Who it affects

Medicare beneficiaries in medically underserved areas gain direct access to pharmacist services without physician referral, potentially improving medication management and reducing barriers to care in areas with physician shortages. The payment structure (80% of 85% of physician fee) is conservative and unlikely to drive overutilization.

Who stands to gain

• pharmacists and pharmacy providers in health professional shortage areas
• pharmacy chains and independent pharmacies operating in medically underserved areas

Named in the bill

Medicare (Title XVIII, Social Security Act), Health and Human Services (HHS), pharmacists (state-licensed), pharmacy providers, health professional shortage areas (HPSA), medically underserved areas (MUA), medically underserved populations (MUP), Public Health Service Act (Section 332, 330), physician fee schedule (Section 1848)

Where it stands

1 cosponsor: 1 Democrats.

• Sep 15, 2025 — Introduced · Congress.gov: “Introduced in Senate”
• Sep 15, 2025 — Referred to Senate Committee on Finance · Congress.gov: “Read twice and referred to the Committee on Finance”

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

Money around this bill

1 lobbying clients named this bill on 1 disclosure filings across 1 quarter, Jun 2026 to Jun 2026. Those filings disclosed $3,282,990 in lobbying spend. A filing names 37 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 0% of bills with at least one filing.

Chuck Grassley, the sponsor, reported $49,167 in PAC receipts in the 2026 cycle.

• Pharmaceutical Care Management Association — $3,282,990 on 1 filing

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