Medicare Part B to Cover Pharmacist Services for Flu, COVID, and Strep Starting 2026

The Equitable Community Access to Pharmacist Services Act is set to make a significant change to how Medicare Part B works, specifically targeting common, acute illnesses. Starting January 1, 2026, Medicare Part B will expand its coverage to include certain services provided by pharmacists, a move that could dramatically change how millions of people access quick care for things like the flu or strep throat.

The Pharmacy Becomes the First Stop

What’s the core of the bill? It allows pharmacists to bill Medicare Part B for services they provide, provided that the service is within their state’s legal scope of practice and done in collaboration with a physician or other approved practitioner. Think of it this way: if a doctor or physician’s assistant could bill Medicare for a service, and your state allows a pharmacist to do the same thing, now Medicare Part B will cover it when the pharmacist does it.

The bill specifically calls out testing and treatment management for four common, high-impact illnesses: COVID-19, the flu, RSV, and strep throat. If you’re a Medicare beneficiary needing a quick test and prescription for one of these, you might soon be able to skip the urgent care line and head straight to your local pharmacy. This is a huge deal for convenience, especially for folks who live in areas where doctor appointments are hard to get.

How the Money Works (And Why It Matters to Your Wallet)

The financial structure here is key. For most covered services, Medicare will pay 80% of the approved cost. This is standard Part B stuff. However, the bill includes a crucial protection for the patient: the pharmacist cannot balance bill you for the covered service. Balance billing is when a provider charges you the difference between their fee and what Medicare actually pays. By prohibiting this, the bill ensures that a trip to the pharmacy for a covered service won't result in surprise, high out-of-pocket costs for Medicare beneficiaries.

The reimbursement rate for the pharmacist is set at 85% of the standard physician payment rate (under Section 1848). This structure aims to incentivize pharmacists to offer these services while keeping costs lower than a full physician visit. Furthermore, if the service addresses a public health need identified during a declared public health emergency (like the recent COVID-19 emergency), Medicare will cover 100% of the approved cost, making it completely free for the patient.

The Collaboration Question and Real-World Impact

The biggest variable here is the requirement for “collaboration” or “supervision” with a doctor, as defined by state law. Since every state defines a pharmacist's scope of practice differently, the actual services covered will vary widely across state lines. This medium level of vagueness means that while the federal government is laying the groundwork, the real expansion of access hinges on how aggressively states define that collaboration and how much autonomy they give pharmacists.

For a busy working adult caring for a Medicare-aged parent, this is a time-saver. Instead of coordinating a full doctor's visit or a trip to an overburdened clinic for a simple flu test, you can utilize the highly accessible pharmacy network. However, this expansion of services will naturally increase expenditures under Medicare Part B. While the benefit is clear for patients, the long-term cost implications for the Medicare trust fund will be something to watch. There's also the potential for some tension with traditional primary care providers, as pharmacists begin handling more low-acuity testing and treatment that previously fell under the physician's billing umbrella.