Ensuring Community Access to Pharmacist Services Act

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3164 Introduced in House (IH)]

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119th CONGRESS
  1st Session
                                H. R. 3164

  To amend title XVIII of the Social Security Act to provide pharmacy 
                      payment of certain services.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                              May 1, 2025

 Mr. Smith of Nebraska (for himself, Mr. Schneider, Mrs. Harshbarger, 
 and Ms. Matsui) introduced the following bill; which was 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

_______________________________________________________________________

                                 A BILL


 
  To amend title XVIII of the Social Security Act to provide pharmacy 
                      payment of certain services.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Ensuring Community Access to 
Pharmacist Services Act''.

SEC. 2. 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.
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