Pharmacy and Medically Underserved Areas Enhancement Act

HR 9365, the Pharmacy and Medically Underserved Areas Enhancement Act, expands Medicare coverage to include pharmacist services in designated underserved areas. It directly affects Medicare beneficiaries in health professional shortage areas, medically underserved areas, or medically underserved populations, as well as pharmacists licensed to provide these services under state law. The bill adds new coverage criteria requiring services to be legally authorized by state law, equivalent to physician-covered services, and provided in an eligible location. It also establishes payment rates at 80% of the lesser of actual charges or 85% of physician fee schedule amounts for these services, effective January 1, 2024. The bill requires the development of specific codes for pharmacist services under Medicare’s physician fee schedule.