Ensuring Community Access to Pharmacist Services Act
- Bill Number
- H.R. 3164
- Origin Chamber
- House
- Congress
- 119th Congress, Session 1
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2026-05-21: Ordered to be Reported in the Nature of a Substitute by Voice Vote.
- Last Updated
- 2026-07-01T08:09:07Z
AI-Generated Summary
Purpose
The Ensuring Community Access to Pharmacist Services Act (H.R. 3164) aims to expand Medicare Part B coverage to include specific services provided by pharmacists, such as testing and treatment for certain infectious diseases and public health emergencies. This would allow pharmacists to deliver these services in a manner similar to physicians, improving access to care in community settings.
Key Provisions
- Coverage Expansion: Amends Section 1861 of the Social Security Act to include "pharmacist services" as a covered benefit under Medicare Part B. These services must be legally authorized under state law and can include evaluation, management, testing, or treatment for:
- COVID-19, influenza, respiratory syncytial virus (RSV), or streptococcal pharyngitis (strep throat).
- Other public health needs during a declared public health emergency (as determined by the Secretary of Health and Human Services).
- Requirements for Services: Pharmacists must provide services under physician supervision or collaboration if required by state law. "Collaboration" is defined as working with a physician or qualified practitioner using jointly developed guidelines or state-defined mechanisms, within the pharmacist's expertise.
- Payment Structure: Establishes reimbursement at 80% of the lesser of the actual charge or 85% of the Medicare physician fee schedule amount (or 100% for services addressing public health emergencies). This mirrors payments for similar physician services.
- Balance Billing Prohibition: Prevents pharmacists from charging Medicare patients more than the approved amount, similar to rules for physicians and other practitioners.
- Effective Date: Applies to services furnished on or after January 1, 2026.
Significant Changes to Existing Law
- Previously, Medicare Part B covered preventive and diagnostic services mainly through physicians or certain practitioners; this bill adds pharmacists as eligible providers for specified infectious disease services, broadening the scope of who can bill Medicare.
- Introduces a new definition for "pharmacist services" in the Social Security Act (subsection 1861(nnn)), aligning them with physician services while respecting state licensing and supervision rules.
- Modifies payment formulas in Section 1833 to incorporate pharmacist reimbursements and extends balance billing protections in Section 1842 to pharmacists.
Potential Impacts
- On Citizens: Medicare beneficiaries, especially those in rural or underserved areas, may gain easier access to timely testing and treatment for common illnesses without needing a doctor's visit, potentially reducing wait times and travel burdens.
- On Government Agencies: The Centers for Medicare & Medicaid Services (CMS) will need to update regulations, payment systems, and oversight to process claims for pharmacist services, which could increase administrative workload but also expand healthcare delivery options.
- On International Relations: No direct impacts, as the bill focuses on domestic Medicare policy.
- Broader Effects: Could lower overall healthcare costs by leveraging pharmacists' roles in community settings, though it may shift some workload from physicians.
Main Stakeholders Affected
- Pharmacists and Pharmacies: Gain new Medicare reimbursement opportunities, enabling them to provide and bill for clinical services.
- Medicare Beneficiaries: Primarily older adults and people with disabilities who rely on Part B for outpatient care.
- Physicians and Healthcare Providers: May see collaboration requirements with pharmacists, potentially altering workflows but promoting team-based care.
- Government Entities: CMS and the Department of Health and Human Services for implementation; Congress for oversight.
- State Governments: Affected by the need to align state laws on pharmacist scope of practice.
Notable Legal, Constitutional, or Political Implications
- Legal: Reinforces federal deference to state laws on healthcare provider scopes, avoiding conflicts with state licensing. Ensures services meet public health standards during emergencies, tying into existing Public Health Service Act authorities.
- Constitutional: No apparent challenges; the bill operates within Congress's enumerated powers under the Spending Clause to regulate Medicare, a federal program.
- Political: Bipartisan sponsorship (from both Republican and Democratic members) suggests broad support for enhancing community-based care. Could influence future expansions of provider roles in Medicare, addressing provider shortages post-pandemic, but may face debate over supervision requirements and cost implications to the Medicare trust fund.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Cosponsors (136)
Rep. Schneider, Bradley Scott [D-IL-10], Rep. Harshbarger, Diana [R-TN-1], Rep. Matsui, Doris O. [D-CA-7], Rep. Kustoff, David [R-TN-8], Rep. Sewell, Terri A. [D-AL-7], Rep. Van Duyne, Beth [R-TX-24], Rep. Doggett, Lloyd [D-TX-37], Rep. Malliotakis, Nicole [R-NY-11], Rep. Ciscomani, Juan [R-AZ-6], Rep. Hern, Kevin [R-OK-1], Rep. Moolenaar, John R. [R-MI-2], Rep. Carey, Mike [R-OH-15], Rep. Tenney, Claudia [R-NY-24], Rep. Davids, Sharice [D-KS-3], Rep. Craig, Angie [D-MN-2], Rep. Trahan, Lori [D-MA-3], Del. Norton, Eleanor Holmes [D-DC-At Large], Rep. Yakym, Rudy [R-IN-2], Rep. Bost, Mike [R-IL-12], Rep. McCormick, Richard [R-GA-7], Rep. LaHood, Darin [R-IL-16], Rep. Krishnamoorthi, Raja [D-IL-8], Rep. Tonko, Paul [D-NY-20], Rep. Johnson, Dusty [R-SD-At Large], Rep. DelBene, Suzan K. [D-WA-1], Rep. Moore, Blake D. [R-UT-1], Rep. Vindman, Eugene Simon [D-VA-7], Rep. Fischbach, Michelle [R-MN-7], Rep. McClellan, Jennifer L. [D-VA-4], Rep. Kelly, Robin L. [D-IL-2], Rep. McGuire, John J. [R-VA-5], Rep. Carter, Earl L. "Buddy" [R-GA-1], Rep. Moran, Nathaniel [R-TX-1], Rep. Steube, W. Gregory [R-FL-17], Rep. Auchincloss, Jake [D-MA-4], Rep. Gottheimer, Josh [D-NJ-5], Rep. Tran, Derek [D-CA-45], Rep. Kiggans, Jennifer A. [R-VA-2], Rep. Soto, Darren [D-FL-9], Rep. Randall, Emily [D-WA-6], Rep. Fitzpatrick, Brian K. [R-PA-1], Rep. Hinson, Ashley [R-IA-2], Rep. Owens, Burgess [R-UT-4], Rep. Veasey, Marc A. [D-TX-33], Rep. Gonzalez, Vicente [D-TX-34], Rep. Miller, Carol D. [R-WV-1], Rep. Mann, Tracey [R-KS-1], Rep. Kim, Young [R-CA-40], Rep. Flood, Mike [R-NE-1], Rep. Salinas, Andrea [D-OR-6] and 86 more
Recent Actions
- 2026-05-21: Ordered to be Reported in the Nature of a Substitute by Voice Vote.
- 2026-05-21: Committee Consideration and Mark-up Session Held
- 2025-05-01: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- 2025-05-01: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- 2025-05-01: Introduced in House
- 2025-05-01: Introduced in House
Bill Versions
- Ensuring Community Access to Pharmacist Services Act — issued 2025-05-01 — PDF (5 pages)