H.R. 3164: Ensuring Community Access to Pharmacist Services Act
Sponsor
Adrian Smith
Republican · NE-3
Bill Progress
Latest Action · May 1, 2025
Referred to Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned. for review
Medicare would pay your pharmacist to treat flu, COVID, strep
Why it matters
When you're on Medicare and come down with the flu, COVID, RSV, or strep, the pharmacy down the block can often test and treat you faster than a doctor's office — but Medicare won't pay a pharmacist for that visit. H.R. 3164 would cover it, paying pharmacists 85% of the physician rate, and the full physician rate during a declared public health emergency.
H.R. 3164 adds a narrow new benefit to Medicare Part B: pharmacists could bill Medicare directly for testing and treating a specific set of illnesses — COVID-19, the flu, RSV, and strep throat — plus services tied to a federally declared public health emergency. Today Medicare generally won't pay a pharmacist for that kind of visit, even when state law already lets them do it.
The point is reach. In rural areas and neighborhoods short on doctors, the pharmacy is often the closest health care there is, and it's open evenings and weekends. Sponsors argue that paying pharmacists to evaluate, test, and treat these infections gets seniors care sooner — before a manageable bug turns into something worse.
This is not a blanket expansion of what pharmacists can do. A pharmacist could only bill Medicare for services their state already authorizes. If state law requires a pharmacist to work under a doctor's supervision or through a collaboration agreement, that requirement stays. The bill creates federal payment; it does not rewrite state scope-of-practice law.
On money, Medicare would base the allowed amount on 85% of what it pays a physician for the same service — the full physician rate for public health emergency services — then pay its usual 80% share of that. Pharmacists would also fall under Medicare's balance-billing ban, so patients couldn't be charged above the approved amount. The bill is broadly bipartisan, with the sponsor and more than 100 cosponsors from both parties, but it still faces the usual fights over Medicare spending and which provider gets paid for what.
H.R. 3164 Bill Summary
What H.R. 3164 actually does.
Pharmacist visits become a Medicare benefit
Medicare Part B would cover pharmacist services that would be covered if a physician provided them, when state law authorizes the pharmacist to perform them.
Covered only for a short list of infections
Limited to evaluation-and-management visits for testing or treating COVID-19, influenza, RSV, and strep throat, plus services addressing a need from a federally declared public health emergency.
State law still decides what your pharmacist can do
A pharmacist can bill Medicare only for services their state already authorizes, including any required physician supervision or collaboration.
Pharmacist pay is set at 85% of the doctor rate
Medicare would set the allowed amount at 85% of the physician fee schedule for the same service — the full 100% for public health emergency services — and pay its standard 80% share of that.
Patients protected from extra charges
Pharmacists would be subject to Medicare's balance-billing ban, so they couldn't charge beneficiaries more than the approved amount for a covered service.
Coverage starts January 1, 2026
The changes would apply to items and services furnished on or after January 1, 2026.
Who benefits from H.R. 3164?
Medicare patients who get sick fast
Seniors who come down with the flu, COVID, RSV, or strep and need testing or treatment within a day or two — when a doctor's appointment may be a week out — could get cared for at the pharmacy instead.
Community pharmacists
A direct Medicare payment path for clinical work many already do under state law, instead of being paid only to dispense medication.
Rural and underserved communities
Places with few doctors but a nearby pharmacy gain a billable front-line option for common respiratory infections.
Public health response
During a declared emergency, pharmacies become a reimbursable testing-and-treatment channel, paid at the full physician rate.
Who is affected by H.R. 3164?
Physicians and clinics
Some routine respiratory testing and treatment may shift to pharmacies; physicians stay involved where state law requires supervision or collaboration.
Pharmacies and pharmacy chains
They would need Medicare billing, documentation, and compliance systems to provide and claim these services for Medicare patients.
The Medicare program
Medicare takes on a new Part B payment category; total cost depends on participation, state rules, and how often beneficiaries use it.
State regulators
Their scope-of-practice rules become the gatekeeper for which pharmacist services can actually be billed to Medicare.
HR3164 Legislative Journey
House: Committee Action
May 1, 2025
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
About the Sponsor
Adrian Smith
Republican, Nebraska's 3rd congressional district · 19 years in Congress
Committees: Joint Committee on Taxation, Ways and Means
View full profile →
Cosponsors (100)
This bill has 100 cosponsors: 48 Democrats, 52 Republicans, reflecting bipartisan support. Cosponsors represent 39 states: Alaska, Alabama, Arkansas, and 36 more.
Bradley Schneider
Democrat · IL
Diana Harshbarger
Republican · TN
Doris Matsui
Democrat · CA
David Kustoff
Republican · TN
Terri Sewell
Democrat · AL
Beth Van Duyne
Republican · TX
Lloyd Doggett
Democrat · TX
Nicole Malliotakis
Republican · NY
Juan Ciscomani
Republican · AZ
Kevin Hern
Republican · OK
John Moolenaar
Republican · MI
Mike Carey
Republican · OH
Cosponsor Coverage Map
Committee Sponsors
Ways and Means Committee
22 of 45 committee members cosponsored
Energy and Commerce Committee
23 of 54 committee members cosponsored
28 Republicans across these committees haven't cosponsored yet. Mobilize their constituents
H.R. 3164 Quick Facts
- Committee
- Ways and Means
- Chamber
- House
- Policy
- Health
- Introduced
- May 1, 2025
Referred to Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned. for review
May 1, 2025
Official Sources
Full text of the Ensuring Community Access to Pharmacist Services Act as introduced in the 119th Congress
Section 1861 of the Social Security Act, which this bill amends to add a new definition of 'pharmacist services' under subsection (nnn)
Section 1833 of the Social Security Act, which this bill amends to set the payment formula for pharmacist services at 85% (or 100% for PHE services) of the physician fee schedule
Section 1848 of the Social Security Act, the physician fee schedule the bill's payment formula explicitly references as the basis pharmacist services are reimbursed against
Section 1842 of the Social Security Act, which this bill amends to extend balance-billing protections to pharmacist-provided services
Section 319 of the Public Health Service Act, referenced in the bill as the authority under which the HHS Secretary declares public health emergencies that trigger expanded pharmacist service coverage
CMS resource hub for pharmacists navigating Medicare enrollment, Part D coverage, and medication therapy management — currently Medicare does not recognize pharmacists as Part B providers, which this bill would change
The Medicare Physician Fee Schedule that H.R. 3164 uses as the payment benchmark — pharmacist services would be reimbursed at 85% (or 100% for PHE) of these rates
Who is lobbying on H.R. 3164?
8 organizations lobbying on this bill
MCKESSON CORPORATION & AFFILIATES U.S. ONCOLOGY AND RX SAVINGS SOLUTIONS (FORMER | 3 |
ABBOTT LABORATORIES | 2 |
CENCORA INC. (FORMERLY AMERISOURCEBERGEN CORPORATION) | 2 |
CVS HEALTH | 2 |
MCKESSON CORPORATION | 2 |
CENCORA FKA AMERISOURCEBERGEN CORPORATION | 2 |
CENCORA, INC. (FORMERLY AMERISOURCEBERGEN CORPORATION) | 2 |
SUTTER HEALTH | 1 |
Showing 1-8 of 8 organizations
H.R. 3164 Common Questions
Can my pharmacist treat me for the flu or COVID on Medicare?
Not under current rules — Medicare generally won't pay a pharmacist for that visit. H.R. 3164 would change that, covering pharmacist testing and treatment for COVID-19, flu, RSV, and strep throat, as long as your state authorizes the pharmacist to provide it.
When would H.R. 3164 take effect?
The bill applies to services furnished on or after January 1, 2026 — but only if it becomes law. As of now it's still in committee, so that date is the target, not a guarantee.
Which illnesses would Medicare cover at the pharmacy?
A short, specific list: COVID-19, influenza, RSV, and strep throat. It also covers pharmacist testing or treatment tied to a federally declared public health emergency. It is not a general expansion of pharmacist care.
Would I pay a pharmacist more than I'd pay a doctor?
No. H.R. 3164 bars pharmacists from balance billing, so they can't charge you above Medicare's approved amount for a covered service. You'd still owe the standard Part B coinsurance, the same as a regular doctor visit.
Does H.R. 3164 let pharmacists do anything they couldn't do before?
No. It only adds Medicare payment. A pharmacist can bill Medicare only for services your state already authorizes — and if state law requires physician supervision or a collaboration agreement, that still applies.
How much would Medicare pay the pharmacist?
Medicare would base payment on 85% of what it pays a physician for the same service (the full 100% for public-health-emergency services), then pay its usual 80% share. For a service valued at $100 for a doctor, that's roughly $68 from Medicare.
Does H.R. 3164 have a real chance of passing?
It has unusually broad bipartisan support — the sponsor plus more than 100 cosponsors from both parties — but it's still in the Energy and Commerce and Ways and Means Committees. Bills like this usually move by being folded into a larger Medicare or year-end health package.
Based on H.R. 3164 bill text
H.R. 3164 Bill Text
“To amend title XVIII of the Social Security Act to provide pharmacy payment of certain services.”
Source: U.S. Government Publishing Office
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