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Pharmacy and Medically Underserved Areas Enhancement Act
To amend title XVIII of the Social Security Act to provide for coverage under the Medicare program of pharmacist services.
Summary
This bill amends the Medicare program to provide coverage for pharmacist services in medically underserved areas. Specifically, it covers services that pharmacists are legally authorized to perform under state law and that would otherwise be covered if provided by a physician, but only when delivered in health professional shortage areas, medically underserved areas, or to medically underserved populations. Medicare would pay 80 percent of the lesser of the actual charge or 85 percent of the physician fee schedule amount for these services. The coverage takes effect on January 1, 2027, and the Secretary of Health and Human Services must develop pharmacist-specific billing codes to implement the program.
AI-generated plain-language summary of the bill text — neutral, and may be imperfect. See the full text below for the exact wording.
Sponsor (1)
- Sen. Grassley, Chuck [R-IA] (R-IA)
1 cosponsor
- Sen. Luján, Ben Ray [D-NM] (D-NM)
Actions (2)
- Sep 15, 2025 Read twice and referred to the Committee on Finance. · senate
- Sep 15, 2025 Introduced in Senate
Similar bills (6)
Bills with similar text or summary — includes reintroductions across Congresses. Ranked by semantic similarity of the bill text (computed locally); a neutral discovery aid, not a claim the bills are duplicates.
Full text
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). <all>
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