Bill Overview
Title: Equitable Community Access to Pharmacist Services Act
Description: This bill expands Medicare coverage to permanently include services provided by a pharmacist, including incidental services and supplies, related to testing, drug regimens, and vaccines for COVID-19, influenza, and certain other illnesses. Specifically, the bill provides for continued coverage of pharmacist services relating to testing and vaccines for COVID-19 and influenza, as well as coverage of testing for respiratory syncytial virus and streptococcal pharyngitis (i.e., strep throat) and the initiation of drug regimens that are used to treat COVID-19, influenza, or strep throat. It also generally provides for coverage of pharmacist services during a public health emergency or to address health equity. A pharmacist, or the facility with which the pharmacist is contracted or employed, may present a claim for reimbursement of 85% (or 100% during a declared emergency) of the applicable amount. A pharmacist may not bill an individual for such a service other than for the applicable deductible or coinsurance amounts.
Sponsors: Rep. Kind, Ron [D-WI-3]
Target Audience
Population: Individuals globally receiving pharmacist healthcare services for select illnesses
Estimated Size: 70000000
- The bill expands Medicare coverage to include pharmacist services, which directly affects Medicare beneficiaries.
- Individuals seeking COVID-19 and influenza tests and vaccines will have improved access to services, which includes a significant portion of the population.
- Strep throat testing and related pharmaceutical interventions are commonly needed services, suggesting a broad impact.
- Public health emergencies, where expanded access to pharmacist services is provided, may affect any segment of the population but typically involve a focus on vulnerable groups.
- Health equity considerations typically address marginalized or underserved communities, which can be sizeable and diverse.
Reasoning
- This policy is focused on enhancing access to essential healthcare services through pharmacies. Given the high number of Medicare beneficiaries, the policy should notably impact older adults and those with chronic health conditions.
- Pharmacists are particularly accessible healthcare providers; their inclusion in reimbursable services means more individuals in need can receive services without the barriers of appointment delays, which often occur in primary healthcare settings.
- The policy intends to mitigate healthcare burdens during public health emergencies, benefiting vulnerable populations significantly. It fosters health equity by making healthcare services more locally and readily available, which is crucial in rural and underserved areas.
- Given the budget constraints, the impact might primarily focus on areas with higher densities of Medicare patients and places identified for public health interventions.
- The common illnesses targeted (COVID-19, influenza, strep throat) are prevalent enough to justify broad-based support, while the integration of pharmacists in healthcare delivery is a potentially scalable solution that reallocates some burden from traditional providers.
Simulated Interviews
Retired teacher (Tennessee)
Age: 72 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 5.0 years
Commonness: 18/20
Statement of Opinion:
- This policy is helpful as it offers more convenient access to required vaccines and tests.
- Pharmacies are usually closer than doctor's offices, and it's beneficial during emergencies.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 7 | 5 |
| Year 5 | 7 | 5 |
| Year 10 | 6 | 4 |
| Year 20 | 5 | 4 |
Software engineer (California)
Age: 45 | Gender: male
Wellbeing Before Policy: 7
Duration of Impact: 2.0 years
Commonness: 16/20
Statement of Opinion:
- I see value in getting easier access to tests and vaccines via my local pharmacy.
- However, since I have a high-deductible plan, my out-of-pocket costs might remain high.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 7 | 7 |
| Year 3 | 7 | 6 |
| Year 5 | 7 | 6 |
| Year 10 | 6 | 6 |
| Year 20 | 6 | 6 |
Freelancer (New York)
Age: 30 | Gender: female
Wellbeing Before Policy: 4
Duration of Impact: 10.0 years
Commonness: 12/20
Statement of Opinion:
- I hope this allows me to access tests and vaccines with less cost.
- I often worry about accessing healthcare services in emergencies.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 4 |
| Year 2 | 6 | 4 |
| Year 3 | 6 | 4 |
| Year 5 | 7 | 4 |
| Year 10 | 6 | 3 |
| Year 20 | 5 | 3 |
Retired (Florida)
Age: 68 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 5.0 years
Commonness: 14/20
Statement of Opinion:
- It's convenient to get services directly from my pharmacy, especially since I have mobility issues.
- I'm also concerned about overdependence on pharmacists for complex health needs.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 7 | 6 |
| Year 5 | 7 | 5 |
| Year 10 | 6 | 5 |
| Year 20 | 5 | 5 |
Small business owner (Texas)
Age: 55 | Gender: female
Wellbeing Before Policy: 8
Duration of Impact: 3.0 years
Commonness: 17/20
Statement of Opinion:
- Having pharmacists provide these services could reduce the healthcare burden on my business.
- My insurance covers a lot already, but the reduced hassle is appreciated.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 8 | 8 |
| Year 2 | 8 | 8 |
| Year 3 | 8 | 8 |
| Year 5 | 8 | 8 |
| Year 10 | 8 | 8 |
| Year 20 | 7 | 7 |
Nurse (Illinois)
Age: 62 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 6.0 years
Commonness: 15/20
Statement of Opinion:
- This is a step in the right direction for health equality—access is key.
- I see first-hand the issues people face getting timely care.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 8 | 6 |
| Year 5 | 8 | 6 |
| Year 10 | 7 | 5 |
| Year 20 | 6 | 5 |
Pharmacist (Ohio)
Age: 33 | Gender: male
Wellbeing Before Policy: 7
Duration of Impact: 10.0 years
Commonness: 13/20
Statement of Opinion:
- This benefits both my profession and my community.
- It positions pharmacists as accessible healthcare providers which is long overdue.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 8 | 7 |
| Year 2 | 8 | 7 |
| Year 3 | 9 | 7 |
| Year 5 | 9 | 7 |
| Year 10 | 8 | 6 |
| Year 20 | 8 | 6 |
College student (Washington)
Age: 22 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 8.0 years
Commonness: 10/20
Statement of Opinion:
- Access to these pharmacy services without the usual financial burden is reassuring.
- I often postpone healthcare needs due to cost.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 7 | 5 |
| Year 3 | 7 | 5 |
| Year 5 | 8 | 5 |
| Year 10 | 7 | 4 |
| Year 20 | 6 | 4 |
Construction worker (Alabama)
Age: 40 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 5.0 years
Commonness: 12/20
Statement of Opinion:
- Convenient strep testing and treatments at the pharmacy could be a big relief.
- I miss work often to see the doctor, which causes financial strain.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 8 | 6 |
| Year 5 | 8 | 5 |
| Year 10 | 7 | 5 |
| Year 20 | 6 | 5 |
Non-profit worker (Oregon)
Age: 27 | Gender: other
Wellbeing Before Policy: 5
Duration of Impact: 10.0 years
Commonness: 11/20
Statement of Opinion:
- The bill could significantly improve access for many without reliable healthcare.
- Coverage through pharmacists helps unveiled discriminatory barriers in traditional healthcare settings.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 7 | 5 |
| Year 5 | 8 | 5 |
| Year 10 | 7 | 5 |
| Year 20 | 6 | 4 |
Cost Estimates
Year 1: $150000000 (Low: $120000000, High: $180000000)
Year 2: $300000000 (Low: $240000000, High: $360000000)
Year 3: $350000000 (Low: $280000000, High: $420000000)
Year 5: $400000000 (Low: $320000000, High: $480000000)
Year 10: $500000000 (Low: $400000000, High: $600000000)
Year 100: $1500000000 (Low: $1200000000, High: $1800000000)
Key Considerations
- Pharmacists' role in health care is increasingly preventative, affecting medication adherence and chronic disease management.
- The broad impact of pharmacists' interventions must consider the savings from prevented diseases.
- Broader health equity measures address systemic gaps, which has nuanced financial implications.
- The implementation phase may need monitoring for unanticipated costs and savings patterns.