Equitable Community Access to Pharmacist Services Act

To amend title XVIII of the Social Security Act to provide pharmacy reimbursement for COVID–19-related and future emergency services. 1. Short title This Act may be cited as the Equitable Community Access to Pharmacist Services Act 2. Coverage of pharmacist services under medicare part B (a) Coverage Section 1861(s)(2) of the Social Security Act ( 42 U.S.C. 1395x(s)(2) (1) in subparagraph (GG), by striking and (2) in subparagraph (HH), by striking the period at the end and inserting ; and (3) by adding at the end the following new subparagraph: (II) pharmacist services and such services and supplies furnished as an incident to the pharmacist’s service as would otherwise be covered under part B if furnished by a physician or as an incident to a physician’s service that— (i) are furnished by a pharmacist, as licensed or otherwise authorized— (I) under State law; or (II) under section 319F–3 or section 361 of the Public Health Service Act, or other similar Federal law; (ii) would otherwise be covered under part B if furnished by a physician, or as incident to a physician’s service; and (iii) are services— (I) for testing and testing-related services for COVID–19, influenza, respiratory syncytial virus, or streptococcal pharyngitis; (II) for the initiation of a drug regimen for COVID–19, influenza, or streptococcal pharyngitis; (III) for the administration of a vaccine and related services for COVID–19 or influenza; (IV) that address a public health need related to a public health emergency under section 319F–3 or section 361 of the Public Health Service Act, or other similar Federal law; or (V) as determined by the Secretary by program instruction or otherwise, including the closing of gaps in health equity. . (b) Payment Section 1833(a)(1) of the Social Security Act ( 42 U.S.C. 1395l(a)(1) (1) by striking and (DD) (DD) (2) by inserting before the semicolon at the end the following: (EE) with respect to pharmacist services described in section 1861(s)(2)(II) for which payment may be made under section 1848, the amounts paid shall be equal to 85 percent (or 100 percent, in the case of such services furnished pursuant to a Federal emergency authority described in clause (i)(II) of such section) of an amount determined by the Secretary or the lesser of the actual charge for the services or the physician fee schedule amount provided under section 1848 if such services had been furnished by a physician (c) Reassignment of payment Section 1833 of the Social Security Act ( 42 U.S.C. 1395l (ee) With respect to pharmacist services described in section 1861(s)(2)(II) payment may be made on the basis of a claim or request for payment presented by the pharmacist furnishing such services, or by a pharmacy, hospital, critical access hospital, skilled nursing facility or nursing facility (as defined in section 1919(a)), physician, group practice, or ambulatory surgical center with which the pharmacist has an employment or contractual relationship that provides for payment to be made under this part for such services to such pharmacy, hospital, critical access hospital, skilled nursing facility or nursing facility, physician, group practice, or ambulatory surgical center. . (d) Prohibition on balance billing for pharmacist services Section 1842(b)(18)(C) of the Social Security Act ( 42 U.S.C. 1395u(b)(18)(C) (vii) A pharmacist. . (e) Rule of construction Nothing in this section shall be construed— (1) to limit flexibilities provided under section 410.32 of title 42, Code of Federal Regulations (or any successor regulation) in response to COVID–19; or (2) to restrict the ability of pharmacies and pharmacists to enroll and obtain reimbursement under existing pathways under title XVIII of the Social Security Act ( 42 U.S.C. 1395 et seq. (f) Implementation authority Notwithstanding any other provision of law, the Secretary of Health and Human Services shall implement the provisions of, and the amendments made by, this section by interim final rule, program instruction, or otherwise not later than the date that is 60 days after the date of the enactment of this Act.

Summary: Equitable Community Access to Pharmacist Services Act This bill expands Medicare coverage to permanently include services provided by a pharmacist, including incidental services and supplies, related to testing, drug regimens, and vaccines for COVID-19, influenza, and certain other illnesses. Specifically, the bill provides for continued coverage of pharmacist services relating to testing and vaccines for COVID-19 and influenza, as well as coverage of testing for respiratory syncytial virus and streptococcal pharyngitis (i.e., strep throat) and the initiation of drug regimens that are used to treat COVID-19, influenza, or strep throat. It also generally provides for coverage of pharmacist services during a public health emergency or to address health equity. A pharmacist, or the facility with which the pharmacist is contracted or employed, may present a claim for reimbursement of 85% (or 100% during a declared emergency) of the applicable amount. A pharmacist may not bill an individual for such a service other than for the applicable deductible or coinsurance amounts.