The Main Street Pharmacy Access Act: A Small Bill Asking a Big Question

Every now and then, a piece of legislation comes along that is relatively modest in scope but raises a much larger question about the future of the pharmacy profession. The Main Street Pharmacy Access Act, formerly called the Ensuring Community Access to Pharmacist Services Act, may be one of those bills.

At first glance, the legislation appears straightforward. It would allow pharmacists to receive Medicare reimbursement for certain testing and treatment services involving common respiratory illnesses, such as influenza, COVID-19, respiratory syncytial virus, and strep throat, provided those services are authorized under applicable state law.¹

That may not sound revolutionary. After all, pharmacists have spent the better part of the last decade expanding their role beyond traditional dispensing activities. Immunizations, point-of-care testing, medication management, and other patient-care services have become increasingly common in pharmacies across the country. Yet the bill raises a broader question: Are pharmacists finally being recognized as frontline health care providers rather than simply dispensers of medications?

The Community Pharmacist Has Changed

For many years, the public perception of pharmacists was simple. A patient dropped off a prescription, the pharmacist filled it, and everyone went about their day. As anyone working in pharmacy knows, that description has been outdated for quite some time.

Today’s pharmacists routinely identify drug interactions, recommend therapies, administer vaccines, perform health screenings, counsel patients, and collaborate with prescribers. During the COVID-19 pandemic, pharmacists became one of the most accessible health care resources in many communities. In some cases, they were the only health care professional a patient could see without an appointment.²

The public noticed. Lawmakers noticed. And, perhaps most importantly, patients noticed. The Main Street Pharmacy Access Act can be viewed as another step in that evolution.

Access to Care Is a Growing Challenge

One of the more compelling arguments supporting the legislation has little to do with pharmacy and everything to do with access. Across the country, patients are facing increasing difficulty obtaining timely appointments with primary care providers. Rural communities continue to struggle with provider shortages. Even in urban areas, patients frequently encounter lengthy wait times for relatively routine medical concerns.³

Meanwhile, the neighborhood pharmacist remains one of the most accessible health care professionals in America. Most pharmacies do not require appointments. Patients can walk in, ask questions, seek guidance, and receive care within minutes rather than days or weeks. The legislation recognizes that reality.

Following the Money

Health care policy often follows a simple rule: Services that are reimbursed tend to expand, whereas services that are not reimbursed tend to remain limited. Pharmacists have long provided valuable clinical services that often go uncompensated. Although many pharmacists willingly perform these services because they improve patient outcomes, there are practical limitations to any model that relies upon providing professional services without reimbursement.

The Main Street Pharmacy Access Act seeks to address that issue by creating a pathway for Medicare payment for certain pharmacist-provided services.¹ In that respect, the bill is not merely about testing and treatment. It is also about recognizing that pharmacists provide valuable professional health care services. That distinction matters.

Provider Status by Another Name?

The provider status debate has existed in pharmacy for decades. Supporters have long argued that pharmacists possess the education, training, and expertise necessary to provide additional patient-care services. Critics have questioned whether pharmacists should be treated similarly to other recognized health care providers for reimbursement purposes.

The Main Street Pharmacy Access Act does not fully resolve that debate. In fact, one could argue that Congress is taking a more cautious approach. Rather than broadly declaring pharmacists to be providers for all purposes, lawmakers are focusing on specific services for specific conditions.

Whether that represents incremental progress or a missed opportunity will likely depend upon whom you ask. Regardless, the legislation appears to acknowledge an important reality: Pharmacists are increasingly involved in direct patient care, and reimbursement models may eventually need to reflect that reality.

Federal and State Roles

An interesting aspect of the bill is the way it balances federal and state authority. Traditionally, states determine what pharmacists may or may not do within their respective scopes of practice. Federal programs such as Medicare, on the other hand, determine what services qualify for reimbursement.

The legislation does not force states to expand pharmacist authority. Instead, it creates reimbursement opportunities where state law already permits pharmacists to provide the services.¹ In other words, states continue to decide what pharmacists can do, while Medicare determines whether pharmacists may be paid for doing it. That may seem like a small distinction, but it reflects the ongoing partnership between state regulation and federal health care policy.

Looking Ahead

Whether the Main Street Pharmacy Access Act ultimately becomes law remains to be seen. As with any legislation, there are political, budgetary, and policy considerations that will influence its future.

What is already clear, however, is that the bill reflects a broader trend. The profession of pharmacy continues to evolve. Patients increasingly view pharmacists as accessible health care resources. Legislators are beginning to recognize the role pharmacists play in expanding access to care. And reimbursement discussions are slowly catching up with what many pharmacists have been doing for years.

The bill itself may be relatively narrow. The question it raises is not. As community pharmacy continues to change, policy makers will inevitably be asked whether pharmacists should remain viewed primarily as dispensers of medications or be recognized more broadly as health care providers who happen to dispense medications as part of the care they deliver.

The Main Street Pharmacy Access Act may not answer that question completely, but it certainly moves the conversation forward.

About the Author

Ned Milenkovich, PharmD, JD, is chair of the health care law practice at Much Shelist, PC and former vice chairman of the Illinois State Board of Pharmacy. He can be reached at 239-877-2124 or [email protected].

REFERENCES

1. Ensuring Community Access to Pharmacist Services Act, HR 3164, 119th Cong (2026). Accessed July 9, 2026. https://www.congress.gov/bill/119th-congress/house-bill/3164/text

2. Pantasri T. Expanded roles of community pharmacists in COVID-19: a scoping literature review. J Am Pharm Assoc (2003). 2022;62(3):649-657. doi:10.1016/j.japh.2021.12.013

3. Rosemergey B, Voran DA. Who’s your doctor? the primary care crisis through the lens of a family physician. Mo Med. 2025;122(5):379-381.