HR3164-119

What This Bill Does

The Ensuring Community Access to Pharmacist Services Act creates a new Medicare Part B benefit for pharmacist services. It amends Social Security Act section 1861 so a pharmacist can be paid for services and incident-to supplies that would otherwise be covered if furnished by a physician, as long as the pharmacist is legally authorized under State law and follows any State supervision or collaboration requirement. The covered services include evaluation and management visits for testing or treatment of COVID-19, influenza, respiratory syncytial virus, and streptococcal pharyngitis, plus testing or treatment services tied to a public health emergency declared under Public Health Service Act section 319. Payment is generally set at 85 percent of the physician fee schedule amount, while public-health-emergency services are paid at 100 percent.

Who Benefits and How

Pharmacist service providers benefit because Medicare Part B would recognize a new paid clinical service category for disease testing, treatment, and emergency-response services. Pharmacy business owners benefit from a new reimbursement stream for state-authorized clinical work that may already occur in community pharmacies. Medicare beneficiaries benefit from more access points for common infectious-disease evaluation and treatment, especially where physician appointments are scarce. Rural Medicare patients and underserved communities benefit if pharmacies can provide quicker testing and treatment access. Public health agencies benefit from a larger clinical workforce during declared emergencies.

Who Bears the Burden and How

The Medicare Part B program and Federal taxpayers bear new payment costs for pharmacist-provided services. The Centers for Medicare and Medicaid Services must implement coverage, billing, supervision, collaboration, and payment rules. Pharmacists must stay within State scope-of-practice law and comply with any physician-supervision or collaboration conditions. Primary care physician practices may lose some routine infectious-disease visits to pharmacy settings. Medicare claims contractors must process and police the new service category.

Key Provisions

• Adds pharmacist services to the Medicare Part B list of covered medical and health services.
• Defines covered pharmacist services as state-authorized services and incident-to supplies that would otherwise be covered if furnished by a physician.
• Provides coverage for evaluation, testing, and treatment of COVID-19, influenza, RSV, and strep throat.
• Provides coverage for testing or treatment services connected to declared public health emergencies.
• Sets payment at 85 percent of the physician fee schedule amount, or 100 percent for public-health-emergency services.