HR3164

This bill amends Section 1861 of the Social Security Act to include "pharmacist services" under Medicare Part B. This means Medicare will now pay for services furnished by pharmacists, including evaluation and management for COVID-19, influenza, RSV, and strep throat, as well as testing and treatment during public health emergencies. This is a direct expansion of reimbursable services for pharmacists, moving beyond traditional prescription dispensing. The money trail flows directly from Medicare Part B to pharmacies and pharmacists. This bill establishes a new revenue stream for pharmacy chains and independent pharmacies by allowing them to bill for services previously covered only if provided by a physician. Companies with large pharmacy footprints, such as CVS Health ($CVS) and Walgreens Boots Alliance, are positioned to capture significant new revenue. Amazon ($AMZN), through its Amazon Pharmacy and One Medical acquisitions, also stands to gain by expanding its healthcare service offerings. UnitedHealth Group ($UNH), as a major Medicare Advantage provider, will see increased claims for these services, but also potential cost savings through more accessible, lower-cost care settings. Historically, similar expansions of provider services under Medicare have led to increased utilization and revenue for the newly covered providers. For example, when nurse practitioners and physician assistants gained broader Medicare reimbursement for services in the 1990s and 2000s, their services saw increased demand and their employers benefited. While direct historical precedent for pharmacist services on this scale is limited, the expansion of covered services typically translates to increased billing opportunities. The 2020 CARES Act, which allowed pharmacists to administer COVID-19 tests and vaccines, demonstrated the capacity and willingness of pharmacies to provide expanded clinical services, leading to significant revenue for pharmacy chains during the pandemic. For instance, CVS Health reported a substantial increase in diagnostic testing and vaccine administration revenue during 2020-2022. Specific winners include CVS Health ($CVS) and Walgreens Boots Alliance, which operate thousands of retail pharmacy locations capable of providing these services. Amazon ($AMZN) will benefit through its growing healthcare division, including Amazon Pharmacy and One Medical, by integrating these new reimbursable services. UnitedHealth Group ($UNH) will manage these new claims through its Medicare Advantage plans, potentially benefiting from a more efficient care delivery model. The bill has 101 cosponsors, indicating strong bipartisan support, and is sponsored by a Republican from Nebraska, suggesting broad appeal. Referral to both Energy and Commerce and Ways and Means committees is standard for healthcare legislation and does not impede progress. The next step is committee consideration. Given the bipartisan support and the nature of the services (addressing common illnesses and public health needs), the bill has a high likelihood of advancing. If passed, the implementation would follow standard regulatory processes by the Centers for Medicare & Medicaid Services (CMS), likely within 12-18 months of enactment.