Medicare expands coverage to pharmacists in underserved areas
S. 2800 — Pharmacy and Medically Underserved Areas Enhancement Act · Filed by Chuck Grassley (R-IA) · 1 cosponsor · Introduced Sep 15, 2025 · Referred to committee
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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 full analysis lists 3 implications of this text.
Who stands to gain
pharmacists and pharmacy providers in health professional shortage areas; pharmacy chains and independent pharmacies operating in medically underserved areas