The Legislation Setting the Stage for Pharmacy’s Next Leap

The Main Street Pharmacy Access Act focuses on some specific and nuanced duties being conducted in community pharmacies, but it may make the world of a difference for the pharmacy industry as a whole if passed during this Congress.

“Pharmacists are successful, accessible, and they're able to deliver high-quality health care services that make a difference,” Chad Worz, PharmD, BCGP, FASCP, executive director and CEO of the American Society of Consultant Pharmacists (ASCP), told Drug Topics®.“If somebody's more compliant because they're getting their monthly antipsychotic shot at the pharmacy, that's a good thing for population health, mental health, and our health care system.”

Formerly known as the Equitable Community Access to Pharmacists Act, and later the Ensuring Community Access to Pharmacists Act, this legislation underwent several revisions before clearing the House Ways and Means Committee as the Main Street Pharmacy Access Act.

READ MORE: The Drug Price Paradox: PBMs, Pharmacies, and the Path to Affordability

In this week’s episode of Over the Counter, Worz joined Drug Topics to explore the bill’s current status, its potential in being signed into law, and what that would mean for pharmacy going forward.

Codifying Test and Treat in Federal Law

According to Worz, the language of the bill codifies pandemic-era flexibilities into federal law, allowing pharmacists to test, treat, and vaccinate for upper respiratory conditions including influenza, COVID-19, pneumococcal disease, as well as respiratory syncytial virus (RSV). Under this framework, a patient visiting a community pharmacy can receive a rapid diagnostic test and immediately obtain appropriate oral antiviral or antimicrobial treatments ordered directly by the pharmacist.

Crucially, the bill amends the Social Security Act to include pharmacists as recognized providers under Medicare Part B, an administrative milestone that pharmacy advocates have pursued for decades.¹

The American College of Clinical Pharmacy emphasized that establishing Medicare Part B coverage for these clinical services expands timely patient access while reducing strain on overburdened primary care systems.²

Currently, the Social Security Act explicitly recognizes various health care professionals, such as physicians, physician assistants, nurse practitioners, and physical therapists, but leaves pharmacists excluded from Part B medical billing. The Academy of Managed Care Pharmacy notes that this omission creates an unnecessary care gap, even though 58% of Americans report they are likely to seek non-emergency care at the pharmacy.^1,3

Aligning Federal Reimbursement with State Authorities

A central pillar of the Main Street Pharmacy Access Act is its requirement for collaborative, team-based care structures with physicians. Worz explained that this collaborative language addresses concerns from medical associations regarding scope of practice while ensuring that federal policy defers to state licensing rules.²

Across the nation, 34 states already authorize pharmacists to provide test-and-treat services independently or through collaborative practice agreements. Furthermore, 28 states mandate coverage for these services through Medicaid and commercial health plans.³

However, because Medicare policy has lagged behind state laws, seniors remain unable to access these reimbursed clinical services at their local pharmacies.

The lack of a direct reimbursement mechanism has historically limited the ability of pharmacists to offer dedicated clinical consultation. As Worz observes, pharmacists currently receive payment only for dispensing or administering a product, rather than for conducting patient care plans or evaluating vaccine hesitancy.

By establishing medical billing codes under Medicare Part B that are independent of product dispensing, the bill creates a sustainable financial model for ongoing clinical care and chronic disease management.

Industry Support and the Future of Practice

More than 190 organizations have voiced strong backing for the legislation, representing senior advocates, health systems, and major retail pharmacy chains. Organizations including the American Pharmacists Association, the American Society of Health-System Pharmacists, and the National Association of Chain Drug Stores have urged swift congressional passage.⁴

Industry leaders point out that with 90% of Americans living within 5 miles of a pharmacy, community practice serves as an essential frontline entry point for health care, particularly in rural and underserved areas.

As pharmacy practice continues to evolve, leaders view the bill as a critical foundation for broader scope expansions. Worz stressed that while the passage of the bill represents a game-changing tipping point, the ultimate success of the law will depend on workforce readiness and ongoing educational preparation across the profession.

By establishing a permanent federal path for team-based clinical care, the legislation positions pharmacists to deliver essential preventive health care services for years to come.²

“This bill is a commonsense, creative solution to address the barriers to health care access that rural and underserved communities suffer every day,” concluded Ways and Means Committee Chairman Jason Smith (R, Missouri), according to a press release from the office of Representative Adrian Smith (R, NE).⁴ “I want to thank Representative Adrian Smith for championing this bill for the benefit of Nebraskans and communities across this country so that seniors will gain access to more primary care conveniently from their local pharmacist.”

Stay tuned for weekly podcast episodes of Over the Counter powered by Drug Topics. Check out our most recent episode with Vanessa Slowey, CEO Of TelyRx. She joined to discuss the ever-growing technological landscape in health care and provided a nuanced discussion surrounding the key focuses regarding how to properly adopt technology within pharmacy.

REFERENCES

1. Provider status for pharmacists. AMCP. October 2024. Accessed September 23, 2026. https://www.amcp.org/legislative-regulatory-position/provider-status-pharmacists

2. Main Street Pharmacy Access Act will establish Medicare coverage for collaborative, team-based patient care. ACCP. May 21, 2026. Accessed September 23, 2026. https://www.accp.com/news/index.aspx?i=453

3. Cosponsor and call for passage of the Main Street Pharmacy Access Act (H.R. 3164) and Equitable Community Access to Pharmacist Services Act (S. 2426). ASHP. Accessed September 23, 2026. https://www.ashp.org/-/media/assets/advocacy-issues/docs/2026/The-Main-Street-Pharmacy-Access-Act-6.pdf?rev=8e808a0f4032408aae2ba2a9da0dd825&hash=CE3FD406E98044158CF35EFB65E885E2

4. What they are saying: Smith's Main Street Pharmacy Access Act clears Ways and Means Committee. Office of Representative Adrian Smith. News Release. May 21, 2026. Accessed September 23, 2026. https://adriansmith.house.gov/media/press-releases/what-they-are-saying-smiths-main-street-pharmacy-access-act-clears-ways-and