Pharmacy and Medically Underserved Areas Enhancement Act
Sponsored By: Senator Chuck Grassley
Introduced
Summary
Would add pharmacist services to Medicare Part B for health professional shortage areas and medically underserved populations. It would set a defined payment rule and require HHS to create pharmacist-specific billing codes for implementation on January 1, 2027.
Show full summary
- Families and patients in shortage and medically underserved areas would be able to receive certain Part B services from licensed pharmacists locally, rather than only from physicians.
- Licensed pharmacists and pharmacy providers could bill Medicare Part B using new codes and would be paid 80 percent of the lesser of their actual charge or 85 percent of the physician fee schedule amount when a physician would have furnished the service.
- Medicare would add a new coverage category under section 1861 and a related payment rule under section 1833 that link pharmacist services to existing physician service rules.
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Bill Overview
Analyzed Economic Effects
1 provisions identified: 0 benefits, 0 costs, 1 mixed.
Medicare covers pharmacists in underserved areas
If enacted, Medicare Part B would cover certain pharmacist services furnished on or after January 1, 2027. Coverage would apply when a State-licensed pharmacist is legally allowed to provide the service. The service must be one Medicare would cover if a physician provided it. The service must be in a health professional shortage area or a medically underserved area or population. Medicare would pay 80% of the lesser of the pharmacist's actual charge or 85% of the physician fee schedule amount. HHS would develop pharmacist billing codes under the physician fee schedule as needed.
Sponsors & CoSponsors
Sponsor
Chuck Grassley
IA • R
Cosponsors
Sen. Luján, Ben Ray [D-NM]
NM • D
Sponsored 9/15/2025
Roll Call Votes
No roll call votes available for this bill.
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