Medicare Covers Pharmacist Testing, Treatment

Summary#

This bill would let Medicare Part B pay for certain services provided by pharmacists. It adds a new definition of “pharmacist services,” limits covered services to specified testing and treatment for respiratory infections and other public-health emergency needs, sets a payment formula, and bans balance billing by pharmacists. The stated goal is to expand community access to pharmacist-delivered testing and treatment, especially during public health emergencies.

• Main change: Medicare Part B would cover pharmacist services that are allowed by State law and that match services Medicare would cover if provided by a physician, limited to certain testing and treatment described in the bill.
• Covered services: Visits for evaluation and management for testing or treatment for COVID-19, influenza, respiratory syncytial virus (RSV), or strep throat; and testing or treatment that addresses a public health need during a declared public health emergency.
• Payment formula: Medicare payment is set by the bill as 80% of the lesser of the pharmacist’s charge or a percentage of the physician fee schedule amount (85% normally, 100% when the service addresses a public health need).
• Balance billing: The bill adds pharmacists to the existing Medicare rules that prohibit balance billing (charging beneficiaries more than Medicare-approved amounts).
• Timing: Applies to services furnished on or after January 1, 2026.

What it means for you#

• Medicare beneficiaries

  • You could get certain tests and treatments from pharmacists billed to Medicare Part B starting Jan 1, 2026.
  • The bill’s payment language means Medicare would pay a share of the allowed amount; the text does not explicitly change Part B deductible or coinsurance rules. This could mean you still owe the usual Part B cost-sharing (commonly 20%) unless you have other coverage, but the bill forbids pharmacists from balance billing you beyond the Medicare-allowed amount.

• Pharmacists and community pharmacies

  • Pharmacists may be able to bill Medicare Part B for specified testing and treatment services they are legally authorized to provide under state law.
  • If state law requires a pharmacist to work under physician supervision or collaboration, the pharmacist must follow that state-required supervision or collaboration.
  • Payment to pharmacists would be lower than the full physician fee schedule in many cases because the bill ties payment to a percentage of the physician rate.

• Physicians and other practitioners

  • The bill requires collaboration or supervision where state law already requires it. That could mean more formal working arrangements where state law requires physician oversight for pharmacist-provided services.

• Government / Medicare program

  • Medicare would have a new category of covered services requiring payment rules and implementation starting in 2026.

Expenses#

No publicly available information on an official cost estimate or fiscal note is included with the bill text.

• The bill would likely increase Medicare Part B spending because it creates a new set of billable services for pharmacists.
• CMS would likely face administrative costs to set up payment rates, billing codes, and any enrollment or claims processes for pharmacists. The bill text does not specify new provider enrollment rules.
• Beneficiaries may face cost-sharing (coinsurance and possibly deductible) for these services unless other coverage applies; the bill does not change deductible or coinsurance rules.
• Private costs for pharmacies could include billing system updates, compliance with Medicare billing rules, and any costs to meet state supervision or collaboration requirements.

Proponents' View#

• The bill appears intended to expand access to testing and basic treatment in the community, particularly for respiratory infections and during public health emergencies.
• It would formally recognize pharmacists as providers for specific services Medicare covers, which could make community pharmacies a more available care site.
• By tying payments to a percentage of the physician fee schedule, the bill creates a predictable payment method for pharmacist services.
• The ban on balance billing protects beneficiaries from extra charges above Medicare-allowed amounts.

Opponents' View#

• One concern is cost: adding a new set of Medicare-covered services for pharmacists would increase federal spending; no cost estimate is provided in the bill text.
• The bill leaves unclear how pharmacists enroll, bill, and fit into existing Part B billing systems, which could create administrative complexity.
• The coverage is limited to specific testing and treatment; critics could say the bill does not address broader pharmacist services or chronic care management.
• Payment is tied to a reduced share of the physician fee schedule (85% then multiplied by 80% in payment language for many services), which may be seen as low and could affect pharmacist participation.
• The bill depends on state laws for supervision or collaboration rules, so access will vary by state and could create uneven implementation.