H.R. 3164: Ensuring Community Access to Pharmacist Services Act
The bill named the Ensuring Community Access to Pharmacist Services Act aims to amend the Social Security Act to include specific pharmacist services under Medicare Part B coverage. Here’s a breakdown of what the bill would accomplish:
Coverage of Pharmacist Services
The bill seeks to formally define and include "pharmacist services" in Medicare, allowing them to be reimbursed. This includes services provided by pharmacists that are authorized under state law, which are similar to those covered when performed by physicians. Specifically, these services may involve:
- Evaluation and management of individuals for COVID-19, influenza, respiratory syncytial virus, and streptococcal pharyngitis.
- Testing or treatment for public health needs during declared health emergencies.
Collaboration Between Pharmacists and Physicians
To provide these services, pharmacists must work in coordination with physicians or other healthcare practitioners per state laws. This collaboration is intended to ensure that pharmacists can deliver care appropriately within their expertise while still receiving the necessary medical direction.
Payment for Pharmacist Services
The bill proposes a specific payment structure for pharmacist services under Medicare. The payments would be set at:
- 80% of either the actual charge for the services or 85% of a preset amount for such services.
- 100% coverage for services related to addressing public health emergencies.
Prohibition on Balance Billing
Additionally, the bill aims to amend existing regulations to prevent "balance billing" for pharmacist services. This means that if a pharmacist provides services covered by Medicare, they cannot charge the patient any additional fees beyond what Medicare reimburses. This protection will also apply to practitioners working with pharmacists.
Implementation Date
The changes proposed would take effect for services rendered on or after January 1, 2026.
Relevant Companies
- CVS - CVS Health Corporation, as a large pharmacy and healthcare provider, may see changes in service offerings and reimbursement models.
- WBA - Walgreens Boots Alliance, being a major pharmacy chain, could be affected by changes in service delivery and partner collab with providers.
This is an AI-generated summary of the bill text. There may be mistakes.
Sponsors
44 bill sponsors
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TrackAdrian Smith
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TrackJake Auchincloss
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TrackMike Bost
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TrackMike Carey
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TrackEarl L. "Buddy" Carter
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TrackJuan Ciscomani
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TrackAngie Craig
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TrackSharice Davids
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TrackSuzan K. DelBene
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TrackLloyd Doggett
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TrackMichelle Fischbach
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TrackBrian K. Fitzpatrick
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TrackJosh Gottheimer
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TrackDiana Harshbarger
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TrackKevin Hern
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TrackAshley Hinson
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TrackDusty Johnson
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TrackRobin L. Kelly
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TrackJennifer Kiggans
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TrackRaja Krishnamoorthi
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TrackDavid Kustoff
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TrackDarin LaHood
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TrackNicole Malliotakis
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TrackDoris O. Matsui
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TrackJennifer L. McClellan
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TrackRichard McCormick
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TrackJohn McGuire
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TrackJohn R. Moolenaar
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TrackBlake D. Moore
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TrackNathaniel Moran
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TrackEleanor Holmes Norton
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TrackBurgess Owens
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TrackEmily Randall
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TrackBradley Scott Schneider
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TrackTerri A. Sewell
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TrackDarren Soto
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TrackW. Gregory Steube
Co-Sponsor
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TrackClaudia Tenney
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TrackPaul Tonko
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TrackLori Trahan
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TrackDerek Tran
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TrackBeth Van Duyne
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TrackEugene Vindman
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TrackRudy Yakym III
Co-Sponsor
Actions
2 actions
| Date | Action |
|---|---|
| May. 01, 2025 | Introduced in House |
| May. 01, 2025 | 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. |
Corporate Lobbying
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