Senators Reintroduce Bill to Improve Pharmacist Medicare Reimbursement

Senators Mark R. Warner (D, Virginia) and John Thune (R, South Dakota) reintroduced the Equitable Community Access to Pharmacist Services (ECAPS) Act (H.R. 1770) on Thursday, according to a news release.¹ If signed into law, the bill would improve Medicare reimbursement rates for pharmacist-administered tests, treatments, and vaccinations.

“During the pandemic, we saw firsthand how pharmacists stepped up to meet urgent health care needs, especially in underserved and rural communities,” said Senator Warner. “This bill builds on that progress by making sure seniors can continue to count on their local pharmacists for routine tests, vaccines, and treatments for common illnesses like flu and COVID. This is a practical step to improve access to care, reduce the burden on hospitals and clinics, and make our health system work better for seniors.”

This bipartisan legislation was first introduced in the House of Representatives on March, 23, 2023, by a coalition of 11 US representatives.^2,3 It was then reintroduced again in May of this year by a smaller subset of the original representatives that introduced the bill.⁴ For a third time, as Congress fails to see it cross the finish line, the ECAPS Act has been reintroduced yet again.

Pharmacy advocates have shown continuous support for the introduction and signing of various bills focused on improving pharmacy sustainability. | image credit: Firman Dasmir / stock.adobe.com

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According to the bill’s official provisions, its main goal is to expand Medicare coverage for US patients, giving them greater access to incidental pharmacy services and supplies related to testing, vaccinating, and treating COVID-19, influenza, respiratory syncytial virus (RSV), and streptococcal pharyngitis (strep throat). Furthermore, the vaccine services mentioned in the bill would include protection against pneumococcal disease, COVID-19, influenza, and hepatitis B.

Aside from the bipartisan support the bill has garnered for over 2 years, it is also celebrated and supported by seniors and pharmacists across the country.

“In rural states like South Dakota, pharmacists are often the most accessible—and sometimes the only—health care provider available to patients,” said Executive Director of the South Dakota Pharmacists Association Amanda Bacon.¹ “The ECAPS Act recognizes the vital role pharmacists play on the front lines of care, especially in areas where access is limited by geography, provider shortages, or both.”

Pharmacy industry advocates were hopeful at the end of 2024 when it was reported that Congress’ end-of-year spending package would include ECAPS language improving pharmacy reimbursement methods.⁵ However, the language was ultimately not included in the final package as incoming Trump Administration leaders went for a more stripped-down version of the deal.⁶

Between the bill first being introduced and now, pharmacy advocates have shown continuous support for the introduction and signing of various bills focused on improving pharmacy sustainability.

One way Congress can improve pharmacy sustainability is through the expansion of pharmacists’ ability to provide clinical services. This expansion of scope is notable within the ECAPS Act and would provide all pharmacists in the US with the ability to perform the aforementioned services.

However, the industry has also been significantly vocal against the way pharmacies are reimbursed for dispensing medications.

Large pharmacy benefit managers (PBMs), otherwise known as prescription drug middlemen, currently control 95% of the prescription drug market due to vertical integration and affiliations with some of the country’s largest pharmacy chains.⁷ Some of the legislation aimed to reform PBMs includes the Better Mental Health Care, Lower-Cost Drugs, and Extenders Act of 2023 (S.3430); Modernizing and Ensuring PBM Accountability Act (S.2973); and Pharmacy Benefit Manager Transparency Act of 2023 (S.127).⁶

Despite a lack of federal PBM reform signed into law, some state-level legislation has been enacted, causing nationwide momentum toward future improvements in pharmacy sustainability.⁸

“We applaud Senator Warner and Senator Thune for championing the reintroduction of the ECAPS Act,” said Executive Director of the Virginia Pharmacy Association Jamie Fisher.¹ “This bipartisan legislation recognizes what patients across Virginia already know—pharmacists are vital, trusted, and accessible members of the health care team.”

Although the ECAPS Act has been reintroduced multiple times without becoming law, there is growing potential for significant changes in pharmacy reimbursement and pharmacist-administered services. As state and federal legislation progresses, industry advocates remain committed to advancing bills like the ECAPS Act to improve pharmacy practice.

“The Future of Pharmacy Care Coalition commends Senate Majority Leader John Thune and Senator Mark Warner for championing the ECAPS Act to ensure seniors, including those living in rural areas and vulnerable communities, can turn to their local pharmacists for testing and treatment services that can protect them from certain common respiratory conditions,” concluded the Future of Pharmacy Care Coalition.¹ “Congress must move with urgency to provide seniors with Medicare coverage in states where pharmacists can offer testing and treatment services for conditions that, although common, can quickly become life-threatening if not properly managed.”

READ MORE: Financial Strains in Pharmacy Leading to New Clinical Service Models

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References

1. Warner, Thune reintroduce legislation to expand seniors’ options for care. News Release. Office of U.S. Senator from the Commonwealth of Virginia Mark R. Warner. July 24, 2025. Accessed July 25, 2025. https://www.warner.senate.gov/public/index.cfm/pressreleases?ID=296149C8-9FEF-4DC5-B94C-474185CE4B71

2. Smith A. Equitable Community Access to Pharmacist Services Act. US Congress. March 23, 2023. Accessed July 25, 2025. https://www.congress.gov/bill/118th-congress/house-bill/1770

3. AMCP welcomes introduction of the Equitable Community Access to Pharmacist Services Act. Academy of Managed Care Pharmacy. March 24, 2023. Accessed July 25, 2025. https://www.amcp.org/press-releases/amcp-welcomes-introduction-equitable-community-access-pharmacist-services-act

4. Congress reintroduces legislation ensuring patient access to pharmacists’ services. ASHP News Center. May 5, 2025. Accessed July 25, 2025. https://news.ashp.org/News/ashp-news/2025/05/05/congress-reintroduces-legislation-ensuring-patient-access-to-pharmacists-services

5. Equitable community access to pharmacist services. American Pharmacists Association. 2025. Accessed July 25, 2025. https://actioncenter.pharmacist.com/campaign/equitable-community-access-to-pharmacist-services/

6. Nowosielski B. PBM reform pulled back in late change to spending package. Drug Topics. December 20, 2024. Accessed July 25, 2025. https://www.drugtopics.com/view/pbm-reform-pulled-back-in-late-change-to-spending-package

7. FTC releases interim staff report on prescription drug middlemen. Federal Trade Commission. July 8, 2024. Accessed July 25, 2025. https://www.ftc.gov/news-events/news/press-releases/2024/07/ftc-releases-interim-staff-report-prescription-drug-middlemen

8. Nowosielski B, Barker B. The overarching implications of PBM reform on the state level. Drug Topics. July 10, 2025. Accessed July 25, 2025. https://www.drugtopics.com/view/the-overarching-implications-of-pbm-reform-on-the-state-level