Why Pharmacist Medicare Reimbursement Reform Matters for Rural and Older Patients

Access to healthcare remains uneven across the United States. For many older adults and people living in rural or medically underserved communities, getting timely care can be difficult. Long travel distances, fewer doctors, and longer wait times are common challenges. As the Medicare population grows, policymakers are looking at how the healthcare workforce can better meet patient needs.

One idea that continues to be discussed is allowing pharmacists to be reimbursed under Medicare Part B for certain clinical services.

What Role Do Pharmacists Play in Patient Care?

Pharmacists play a critical role in optimizing medication regimens, reducing inappropriate prescribing, and improving medication adherence, yet reimbursement restrictions prevent them from delivering these services consistently. Many patients already rely on pharmacists for help understanding medications, managing chronic conditions, and knowing when to follow up with a doctor. However, how Medicare pays for care determines which services pharmacists can realistically provide and be compensated for.

A Simple Explanation of Medicare Parts B and D

Medicare Part B covers outpatient medical care such as doctor visits, preventive services, and chronic disease management (CMS). Even though pharmacists often provide patient-facing clinical services, they are not currently recognized as providers under Part B. This means Medicare does not pay pharmacists directly for these services.

Instead, pharmacist reimbursement mainly occurs under Medicare Part D, which focuses on prescription drug coverage. Part D includes a program called Medication Therapy Management (MTM), where pharmacists help certain patients improve medication use (CMS MTM Guidance).

The challenge is that MTM eligibility is very specific. Patients must meet certain criteria related to the number of medications they take, chronic conditions, and drug costs. Many Medicare beneficiaries who could benefit from pharmacist support do not qualify.

How Are Pharmacists Paid Today?

When pharmacists provide services outside of MTM, payment often occurs through something called incident-to billing, which means the service is billed under a physician’s care. While this supports teamwork, it also has limitations. The pharmacist is able to bill incident to a physician but cannot provide services unless the physician has already seen the patient (Dietrich & Gums).

In rural areas, where doctors may be hard to access, this requirement can delay care that could otherwise be handled more quickly.

Why This Matters for Older and Rural Patients

Older adults often manage multiple chronic conditions and complex treatment plans. Research shows that when pharmacists work closely with physicians as part of a care team, patients experience better outcomes and fewer hospital readmissions (ASHP; Colla et al.).

Rural communities often face unique barriers to care, including fewer healthcare providers, longer travel distances, and limited access to specialty services. In many of these areas, a local pharmacy may be one of the most accessible healthcare settings available. Allowing pharmacists to be reimbursed under Medicare Part B for appropriate clinical services could help address these access gaps by supporting care that patients are already receiving close to home. When pharmacists are able to provide services such as chronic disease support, preventive care, and coordination with physicians, patients may experience fewer delays in care. Importantly, this approach supports physician-led, team-based care rather than replacing it, helping extend the reach of healthcare teams in communities where provider shortages are most common.

Previous legislative proposals like the Pharmacy and Medically Underserved Areas Enhancement Act focus on improving access for rural seniors, not expanding pharmacist independence (GovTrack).

The Bottom Line

Medicare Part B pharmacist reimbursement is less about changing roles and more about increasing access. Supporting team-based care that includes pharmacists may be one practical way to improve access, especially for older adults and rural communities.