AMCP Applauds ECAPS Act of 2025: Adam Colborn, JD

The Ensuring Community Access to Pharmacist Services (ECAPS) Act of 2025 is a bipartisan bill that would ensure that Americans continue to have reliable access to testing and treatment for respiratory illnesses, including COVID-19, respiratory syncytial virus (RSV), the flu, and other potential future threats to public health, Adam Colborn, JD, associate vice president for congressional affairs, Academy of Managed Care Pharmacy (AMCP), explained.

This transcript was lightly edited; captions were auto-generated.

Transcript

Can you discuss the role of the pharmacist in combatting a range of respiratory illnesses and other public health threats under the ECAPS Act?

Pharmacists are an important part of the public health infrastructure in the United States. More than 90% of Americans live within 5 miles of a pharmacy. Patients, on average, see their pharmacist twice as often as they see their primary care physician, and they are really part of the backbone of our approach to treating public health issues, and that's especially important in flu season. We call it flu season, but there are other respiratory illnesses that are very common during those cold months as well. You've got RSV, strep throat, and COVID-19 that are all sort of bundled up in this act, and what ECAPS would do is authorize Medicare reimbursement under Part B for services related to the testing and treatment of those respiratory illnesses that I just listed.

This is really, I think, crucial today, because we see so many of these services being done at pharmacies. I was on the Hill yesterday with a member of ours at AMCP advocating for this bill, and he's a Medicare beneficiary, and he mentioned that his primary care physician doesn't even stock many of these tests. He doesn't stock a flu test because many people do it at a pharmacy or they're at urgent care or ER, and it just doesn't make sense for a primary care doc to have these. The issue that we have is, if you're going to the ER for something like an RSV test, that is really burdensome for both the patient and the health care system. That's a really burdensome approach.

Right now, pharmacies and pharmacists do provide these tests to Medicare beneficiaries, but they don't get paid for it. This is an important policy to help ensure that pharmacists and pharmacies are able to continue providing these services. It's a question of public health, it's a question of patient access, and it's a question of keeping pharmacies open to help provide these important services to communities.

If signed into law, can you discuss the provisions and coverage/reimbursement policies that would be put into place under this act?

To dig a little bit deeper on the specific policies, what ECAPS would do is add pharmacists to the list of providers that are eligible to receive reimbursement under Medicare Part B. Right now, they don't. Some commercial plans will reimburse pharmacists for their services. Many Medicaid programs do reimburse pharmacists, but they're not eligible for Medicare reimbursement at all.

The way the bill works is it defines these treatments that pharmacists are eligible to perform, and it ties their reimbursement to the lesser of 80% of the actual charge, or 85% of the amount that would be paid to a physician for the same service. It's not quite at that level where you're going to a doctor. This is, I think, a good approach for Medicare, as well, because it's directing people to an accessible health care provider. It's reducing the burden on ERs and urgent care centers. Statistically, it is probably reducing hospitalizations.

One of the other things that the bill does is automatically authorize pharmacists to perform certain services in the event of a public health emergency. When we went through the COVID-19 pandemic, HHS basically had to go 1 by 1 and authorize emergency use for COVID-19 shots, but then they also had to go and authorize reimbursement for flu and RSV separately. This bill, in addition to permanently adding pharmacists to the Medicare provider list for those services, ensures that if there's something new that we declare a public health emergency for, and they are within their scope of practice able to address, then they automatically get that, and HHS doesn't have to go through and jump through all those hoops to authorize Medicare coverage for those services at pharmacies.