Medicare Part B Expands Coverage to Pharmacists for Flu, Strep, and COVID Testing Starting 2026

The “Ensuring Community Access to Pharmacist Services Act” is pretty straightforward: it updates Medicare Part B to start paying for certain clinical services provided by pharmacists, kicking off on January 1, 2026. This isn't about covering your prescriptions; it's about covering the testing and treatment for specific, common illnesses, making your local pharmacy a more robust point of care.

The Pharmacy Becomes a Clinic

What exactly is covered? The bill defines “pharmacist services” as those a pharmacist is legally allowed to perform under state law, including any required supplies. Crucially, the coverage is limited to testing and treatment for COVID-19, the flu, Respiratory Syncytial Virus (RSV), and strep throat. It also covers services addressing public health needs during a declared public health emergency. Think about it this way: if you’re a Medicare beneficiary and you feel a cold coming on, you might be able to skip the urgent care line and get tested and treated for the flu right at your pharmacy counter, assuming your state allows pharmacists to provide that level of care.

This is a big deal for access, especially for people in rural areas or those who struggle to get a quick doctor’s appointment. However, there’s a catch tied to state law: if your state requires the pharmacist to work under the supervision of, or in collaboration with, a doctor, that requirement must be met for Medicare to pay. This collaboration requirement means that while pharmacists gain new responsibilities, they aren't fully independent operators under this federal program, which could add administrative steps for both pharmacists and physicians.

The Cost Breakdown: No Surprise Bills

For most of these covered services, Medicare will pay 80% of the cost. The actual payment amount is capped at 85% of what a doctor would typically get paid for a similar service. If the service is related to a public health emergency—like a massive COVID-19 testing effort—Medicare pays 100% of the cost. This is designed to keep care affordable and accessible when the community needs it most.

Perhaps the most consumer-friendly part of this section is the ban on “balance billing.” If you’re a Medicare patient, your pharmacist can’t charge you the difference between what they charge and what Medicare approves. This is a huge protection against surprise bills and ensures that the out-of-pocket costs remain predictable, which is essential for people managing tight budgets.

Real-World Impact and Inconsistent Coverage

For the average person aged 25-45, this change primarily affects your parents or grandparents on Medicare, offering them a faster, more convenient way to get basic diagnostic care. It might also ease the burden on crowded primary care offices and emergency rooms during flu season. If you work in a healthcare setting, you’ll see the pharmacist’s role expand, shifting some basic diagnostic work out of the clinic and into the community setting.

The main challenge here is the variability across the country. The bill’s reliance on “state’s laws” means that a Medicare patient in one state might be able to get a strep test and treatment at the pharmacy, while a patient in a neighboring state might not, because their state hasn't authorized pharmacists to perform those services. This introduces an element of inconsistency into Medicare coverage, which is usually standardized nationwide. While this approach respects state autonomy, it means the full benefit of this bill will only be realized as states update their own regulations regarding the scope of pharmacist practice.