Coverage of pharmacist services under medicare part B

(a)

Coverage

Section 1861 of the Social Security Act (42 U.S.C. 1395x) is amended— (1) in subsection (s)(2)— (A) in subparagraph (JJ), by adding and at the end; and (B) by adding at the end the following new subparagraph:

(KK) pharmacist services (as defined in subsection (nnn));

; and

(2) by adding at the end the following new subsection:

(nnn)

Pharmacist services

(1)

In general

The term pharmacist services means such services furnished by a pharmacist, and such services and supplies furnished as an incident to the pharmacist’s service, which the pharmacist is legally authorized to perform under State law as would otherwise be covered if furnished by a physician or as an incident to a physicians’ service which— (A) in the case such State law requires such services to be furnished under the supervision of, or working in collaboration with, a physician or practitioner (as defined in section 1842(b)(18)(C)(i)), are so furnished under the supervision of, or working in collaboration with, such physician or practitioner in the manner and to the extent as so required by such State law; and (B) are— (i) for visits for the evaluation and management of individuals for testing or treatment for COVID–19, influenza, respiratory syncytial virus, or streptococcal pharyngitis; or (ii) testing or treatment services that address a public health need related to a public health emergency declared under section 319 of the Public Health Service Act (as determined by the Secretary). (2)

Collaboration

For purposes of this subsection, the term collaboration means a process in which a pharmacist works with a physician or practitioner (as defined in section 1842(b)(18)(C)(i)), as applicable, to deliver health care services within the scope of the pharmacist’s professional expertise, with medical direction and appropriate supervision as provided for in jointly developed guidelines or other mechanisms as defined by the law of the State in which the services are performed.

(b)

Payment

Section 1833(a)(1) of the Social Security Act (42 U.S.C. 1395l(a)(1)) is amended— (1) by striking and (HH) and inserting (HH); and (2) by inserting before the semicolon at the end the following: , and (II) with respect to pharmacist services (as defined in section 1861(nnn)), the amounts paid shall be equal to 80 percent of the lesser of (i) the actual charge for the services or (ii) 85 percent (or 100 percent, in the case of such services that address a public health need described in paragraph (2)(B) of such section) of the amount determined under the payment basis under section 1848 for such services.. (c)

Prohibition on balance billing for pharmacist services

Section 1842(b)(18) of the Social Security Act (42 U.S.C. 1395u(b)(18)) is amended— (1) in subparagraph (A), by inserting or a pharmacist after a practitioner described in subparagraph (C); and (2) in subparagraph (B)— (A) in the first sentence, by inserting , a pharmacist, after a practitioner described in subparagraph (C); and (B) in the third sentence— (i) by inserting , a pharmacist, after a practitioner; and (ii) by inserting , the pharmacist, after the practitioner. (d)

Application

The amendments made by this section shall apply to items and services furnished on or after January 1, 2026.