Pharmacists Get Medicare Coverage Under Part B, But Only in Underserved Areas Starting 2027

The “Pharmacy and Medically Underserved Areas Enhancement Act” is straightforward: it expands what Medicare Part B will pay for by adding certain services provided by licensed pharmacists. Think of it as a policy nod to the fact that in a lot of places, the pharmacist is often the most accessible medical professional.

The New Prescription for Rural Healthcare

The core change is buried in Section 2, which expands Medicare Part B coverage. Currently, Medicare mostly pays for services delivered by a doctor or as part of a doctor’s service. This bill changes that by recognizing pharmacists as providers for certain services, provided they are licensed to perform those services in their state. This is a big deal because it means Medicare is finally paying for the full scope of a pharmacist’s training, not just for dispensing pills. However, there’s a major catch: this coverage is strictly limited to services provided in areas designated as a health professional shortage area or a medically underserved area (SEC. 2). If you live in a well-staffed suburb, this change won’t affect your Medicare coverage. This bill is laser-focused on plugging healthcare gaps in rural and underserved communities, where a primary care doctor might be an hour’s drive away. For a senior living in a remote town, this could mean getting essential preventative care or chronic disease management right at their local pharmacy, saving them a long trip.

The Payment Structure: What Does it Cost?

For the pharmacists who step up to provide these services in underserved areas, the bill sets a specific payment formula. Medicare will pay 80% of the lower amount between the pharmacist's actual charge or 85% of what a physician would normally be paid for that exact same service (SEC. 2). This payment structure is a bit of a mixed bag. On one hand, it guarantees payment for services that weren't previously covered, which is a win for pharmacists. On the other hand, capping the reimbursement at 85% of the physician rate means that while pharmacists are filling a critical need, they are being paid less than physicians for the same service. This might make some pharmacists think twice about the financial viability of expanding these services, especially considering the already tight margins many local pharmacies face.

Why Wait Until 2027?

If this bill passes, don't expect immediate changes. The new coverage rules apply to services provided on or after January 1, 2027. The delay is primarily administrative. Before the coverage starts, the Secretary of Health and Human Services has to develop specific billing codes for pharmacists (SEC. 2). This is necessary because the payment system relies on calculating the pharmacist's rate based on the existing physician fee schedule. Getting the coding right is crucial for accurate payment, and since the government moves slowly, this three-year window is dedicated to building out the necessary infrastructure. For the 25-to-45 crowd, this means that while your parents or grandparents in rural areas stand to benefit, the actual impact is still a few years down the road.