Medical Necessity & Prior Authorization

Modernize coverage determinations for lab services.

Lab on the Equitable Community Access to Pharmacist services (ECAPS) Act — H.R. 7213

  • ECAPS provides coverage to pharmacist services under Medicare Part B specific to :

    • Testing and testing related services for COVID-19, influenza, respiratory synctial virus, or streptococcal pharyngitis;

    • Inflating a pharmaceutical regimen for COVID-19, influenza, or streptococcal pharygitis;

    • Vaccine administration for COVID-19 or influenza;

    • Addressing the needs of a public health emergency.

  • Part B Pharmacists services will be reimbursed at 85% of the rate.

  • Prohibits balanced billing by pharmacists.

There is broad interest in maintaining access to certain services at pharmacies following the expiration of the PHE, but there is apprehension to giving pharmacists status as providers under Medicare. One suggesting is that pharmacies should partner with labs to receive Medicare reimbursement. access to medical services at pharmacies is likely to continue beyond the PHE because people have grown to like the convenience it offers.