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S. 2426: Equitable Community Access to Pharmacist Services Act

The Equitable Community Access to Pharmacist Services Act aims to expand the role of pharmacists in providing healthcare services covered under Medicare Part B. Here is a breakdown of what the bill would do:

Coverage of Pharmacist Services

The bill proposes to amend the Social Security Act to include coverage for certain pharmacist services under Medicare. These services would be defined as those legally authorized for pharmacists to perform and would typically require the collaboration or supervision of a physician, as per state laws.

Definition of Pharmacist Services

The bill outlines that pharmacist services can include:

Evaluation and management visits related to testing or treatment for various conditions, including COVID-19 and influenza.
Testing or treatment services that address public health needs related to an emergency as defined by the Secretary of Health and Human Services.

Collaboration with Healthcare Providers

For the provision of these services, pharmacists are expected to work collaboratively with physicians, ensuring services are delivered within the pharmacist’s area of expertise alongside medical oversight.

Payment Provisions

Under the proposed changes, payments for pharmacist services would be structured as follows:

Medicare would cover 80% of the charges for such services, with special provisions that might allow for up to 100% coverage in cases addressing urgent public health needs.

Prohibition on Balance Billing

The bill includes a provision against balance billing for services provided by pharmacists, which means that pharmacists would not be allowed to bill patients for the difference if the service charge exceeds what Medicare covers.

Implementation Timeline

The provisions of the bill would take effect for services provided on or after January 1, 2026. This sets a timeline for when these changes would begin to impact the delivery of pharmacist services under Medicare.