Pharmacy and Medically Underserved Areas Enhancement Act
Summary
SB 2800, the Pharmacy and Medically Underserved Areas Enhancement Act, would expand Medicare to cover certain services furnished by pharmacists when those services are provided by a pharmacist licensed under state law and acting within the scope of authority in that state. The bill limits coverage to services that would otherwise be covered if furnished by a physician or incident to a physician’s service, and only when delivered in a health professional shortage area, medically underserved area, or medically underserved population.
The bill also directs Medicare payment rules for these pharmacist services. Payment would generally be set at 80 percent of the lesser of the actual charge or 85 percent of the physician fee schedule amount that would apply if a physician furnished the service. The Secretary of Health and Human Services would be required to develop pharmacist-specific billing codes as needed under the physician fee schedule. The amendments would take effect for services furnished on or after January 1, 2027.
Impact
If enacted, the bill would amend the Social Security Act to add a new category of covered Medicare services for pharmacists and create a corresponding payment methodology under Medicare Part B. It would affect Medicare beneficiaries in underserved communities, pharmacists, pharmacies, and providers operating in shortage areas by allowing reimbursement for qualifying pharmacist-delivered services. It would also require federal implementation work by HHS to establish billing codes and payment administration, while leaving state licensure and scope-of-practice limits in place as a condition of coverage.
Sentiment
The available context suggests generally favorable bipartisan interest in the bill’s goals, as it was introduced by Senators Grassley and Luján, indicating support across party lines for expanding access to care in underserved areas. No committee transcript or vote record is provided, so there is no evidence of formal opposition or amendment debate in the available materials. The bill’s framing as an access-to-care measure suggests a positive policy reception focused on improving service availability through pharmacists.
Contention
The main likely points of contention are the scope of covered pharmacist services, how closely those services must mirror physician-covered services, and the payment rate relative to physician fee schedule amounts. Another possible issue is federal implementation complexity, including the need for pharmacist-specific codes and coordination with varying state scope-of-practice laws. Stakeholders most likely to focus on these issues include pharmacists and pharmacy organizations seeking broader reimbursement, physician groups concerned about role expansion or payment parity, and Medicare administrators focused on program integrity and billing rules.
Physicians for Underserved Areas ActThis bill modifies how a hospital's residency positions are redistributed after it closes for purposes of graduate medical education payments under Medicare.Under current law, if a hospital with an approved medical residency program closes, the Centers for Medicare & Medicaid Services (CMS) must redistribute the hospital's residency positions to other hospitals in the following order: (1) hospitals in the same core-based statistical area as the closed hospital, (2) hospitals in the same state as the closed hospital, (3) hospitals in the same region of the country as the closed hospital, and (4) other remaining hospitals. In order to receive the additional positions, hospitals must demonstrate a likelihood of filling the positions within three years.The bill removes the requirement that the CMS prioritize hospitals in the same region of the country as the closed hospital. It also requires hospitals to demonstrate a likelihood of (1) starting to use the positions within two years, and (2) filling the positions within five years.