The Future of Health Care Access Runs Through the Pharmacy

A senior walks into her local pharmacy with a sore throat that has gotten worse over 2 days. She does not want to wait a week to get an appointment with her physician, and she also does not want to spend her afternoon in an urgent care waiting room. Her pharmacist is right there, behind the counter, 5 minutes from her house. In more than 12 states, that pharmacist is legally authorized to test her for strep and start treatment on the spot.¹

Here is the part that does not make sense: If that patient is on Medicare, her pharmacist can still run the test and prescribe the treatment under state law, but Medicare will not recognize the pharmacist as a provider, meaning there is no path to reimbursement for the service. The patient either pays out of pocket or the pharmacy absorbs the cost of care it is already legally qualified to deliver.

Pharmacists are trained and licensed to provide this level of care, and we are not asking for new clinical authority. In many states, we already have it. There is a need for a Medicare system that has caught up with the care that is given in today’s pharmacies.

That is the problem the Main Street Pharmacy Access Act is trying to fix. It would let pharmacists bill Medicare Part B for testing and treating a short list of respiratory illnesses, including influenza, COVID-19, respiratory syncytial virus, and strep, in states where we are already authorized to do it. It does not expand anyone’s scope of practice, nor does it override any state-specific rules. It tells Medicare to stop pretending pharmacists are not sufficient in providing services that state law already recognizes they are eligible to provide.²

The shortage of primary care physicians continues to grow, with projected shortfalls of up to 86,000 physicians by 2036, with critical gaps in geriatrics and family medicine and especially in rural areas.^3,4 At the same time, nearly 90% of Americans live within 5 miles of a pharmacy.⁵

I support this bill, and I hope that Congress will move it forward before the end of the year. However, I also caution against treating passage of this bill as the finish line.

Billing codes still do not account for time. Right now, most community pharmacists spend a lot of their working hours dispensing medications, counting, filling, verifying, and calling insurance companies about rejected claims. That work is essential, and it must be done well. However, many pharmacists entered into this profession to build relationships with patients and have ended up managing a prescription-fulfillment operation instead.

If Congress hands pharmacists a new clinical mandate without addressing the workload that is already consuming their day-to-day, we have not actually solved the access problem. We have just handed an already-stretched workforce an additional responsibility. While passing this bill is necessary, we must also give pharmacists the time to care for these patients.

This is where I think the industry needs to be honest about infrastructure, not just legislation. Central fulfillment solutions consolidate routine prescriptions to dedicated, high-volume facilities. Leveraging robotics, automation, and intelligent software, these solutions can fill thousands of prescriptions per hour. This can allow the pharmacist standing at the counter to focus on patients. You cannot bill Medicare for a 10-minute strep consult if you do not have 10 minutes. Central fill is how pharmacists can get them back.

We need the Main Street Pharmacy Access Act, but if we want it to actually change what happens when a patient walks up to the counter, the policy conversation in Washington has to be matched by an operational one back at the pharmacy. How will we fill the prescriptions so the pharmacist has time to treat the patient? Recognizing pharmacists as providers is the right call. Now we have to make sure we have built pharmacies where that recognition can mean something.

REFERENCES

1. Pharmacist Test-and-Treat Authority: Which States Allow It. News release. RxByState. May 28, 2026. Accessed September 28, 2026. https://rxbystate.com/blog/pharmacist-test-and-treat-authority-by-state

2. H.R. 3164, Main Street Pharmacy Access Act. May 21, 2026. Accessed September 28, 2026. https://www.cbo.gov/publication/62827

3. Dall T, Reynolds R, Chakrabarti R, Ruttinger C, Zarek P, Parker O. The Complexities of Physician Supply and Demand: Projections From 2021 to 2036. March 2024. Accessed September 28, 2026. https://www.aamc.org/media/75236/download

4. New AAMC report shows continuing projected physician shortage. Press release. Association of American Medical Colleges. March 21, 2024. Accessed September 28, 2026. https://www.aamc.org/news/press-releases/new-aamc-report-shows-continuing-projected-physician-shortage

5. NACDS highlights pharmacies as key drivers of better nutrition and healthier communities during National Nutrition Month. News release. National Association of Chain Drug Stores. March 26, 2026. Accessed September 28, 2026. https://www.nacds.org/nacds-highlights-pharmacies-as-key-drivers-of-better-nutrition-and-healthier-communities-during-national-nutrition-month/