Pharmacy and Medically Underserved Areas Enhancement Act

Pharmacy and Medically Underserved Areas Enhancement Act

This bill provides for Medicare coverage and payment with respect to certain pharmacist services that (1) are furnished by a pharmacist in a health-professional shortage area, and (2) would otherwise be covered under Medicare if furnished by a physician.

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[S. 2800 Introduced in Senate (IS)]

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119th CONGRESS
  1st Session
                                S. 2800

To amend title XVIII of the Social Security Act to provide for coverage 
           under the Medicare program of pharmacist services.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                           September 15, 2025

Mr. Grassley (for himself and Mr. Lujan) introduced the following bill; 
     which was read twice and referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
To amend title XVIII of the Social Security Act to provide for coverage 
           under the Medicare program of pharmacist 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 ``Pharmacy and Medically Underserved 
Areas Enhancement Act''.

SEC. 2. MEDICARE COVERAGE OF PHARMACIST SERVICES.

    (a) Coverage.--Section 1861(s)(2) of the Social Security Act (42 
U.S.C. 1395x(s)(2)) is amended--
            (1) in subparagraph (JJ), by inserting ``and'' at the end; 
        and
            (2) by adding at the end the following new subparagraph:
            ``(KK) pharmacist services furnished by a pharmacist, as 
        licensed by State law, individually or on behalf of a pharmacy 
        provider--
                    ``(i) which the pharmacist is legally authorized to 
                perform in the State in which the individual performs 
                such services;
                    ``(ii) as would otherwise be covered under this 
                part if furnished by a physician, or as an incident to 
                a physician's service; and
                    ``(iii) in a setting located in a health 
                professional shortage area (as defined in section 
                332(a)(1)(A) of the Public Health Service Act), 
                medically underserved area, or medically underserved 
                population (as defined in section 330(b)(3) of such 
                Act);''.
    (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(s)(2)(KK)), the amounts paid shall be 
        equal to 80 percent of the lesser of the actual charge or 85 
        percent of the fee schedule amount provided under section 1848 
        if such services had been furnished by a physician''.
    (c) Effective Date; Pharmacist Specific Codes.--
            (1) Effective date.--The amendments made by subsections (a) 
        and (b) shall apply with respect to services furnished on or 
        after January 1, 2027.
            (2) Pharmacist specific codes.--The Secretary of Health and 
        Human Services shall develop pharmacist specific codes, as 
        necessary, under the physician fee schedule under section 1848 
        of the Social Security Act (42 U.S.C. 1395w-4).
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