Radiology Groups Warn of Risks in Proposed Bill Expanding Pharmacist Practice Authority
A new bipartisan bill aiming to broaden pharmacists’ authority under Medicare has drawn sharp criticism from radiologists and other physician groups, who warn it could carry “dangerous long-term consequences” if enacted.
The Equitable Community Access to Pharmacist Services Act, reintroduced in the Senate by Sens. Mark R. Warner (D-Va.) and John Thune (R-S.D.) after a House version debuted earlier this year, would allow Medicare to reimburse pharmacists for administering certain tests, treatments, and vaccines—including for influenza, RSV, COVID-19, and strep throat—“in accordance with state scope-of-practice laws.”
Supporters say the bill could improve access to care, particularly in rural areas where provider shortages persist. “This bill builds on [pandemic-era] progress by making sure seniors can continue to count on their local pharmacists for routine tests, vaccines, and treatments for common illnesses like flu and COVID,” Sen. Warner said on July 24. “This is a practical step to improve access to care, reduce the burden on hospitals and clinics, and make our health system work better for seniors.” The legislation currently has 48 House co-sponsors and eight in the Senate, with backing from pharmacy organizations and companies such as CVS, Walgreens, Walmart, and McKesson.
However, the American College of Radiology (ACR) and American Society of Neuroradiology (ASNR), along with 30 other national medical societies and nearly every state medical association, have urged lawmakers to reject the proposal. In an Aug. 8 update, ASNR said the bill contains “numerous shortcomings”—chief among them granting pharmacists authority to perform services typically reserved for physicians.
Physician groups argue that pharmacists lack the extensive training required for evaluating and managing patients for conditions such as COVID-19, influenza, RSV, or streptococcal pharyngitis. These diagnoses, they say, demand a comprehensive physical exam—a skill not included in pharmacists’ training. While the bill allows for such services under “collaborative practice agreements” with physicians, opponents contend that meaningful collaboration is unlikely in most community pharmacy settings.
The physician organizations also stress the stark differences in training: physicians complete four years of medical school, up to seven years of residency, and as many as 16,000 hours of clinical training; pharmacists typically undergo four years of education, no residency, and about 1,740 hours of training.
“Physician-led, team-based care has a proven track record of success in improving the quality of patient care, reducing costs, and allowing all healthcare professionals to spend more time with their patients,” ACR, ASNR, and others wrote in a July 24 letter to House sponsors Reps. Adrian Smith (R-Neb.) and Brad Schneier (D-Ill.). “We are concerned that the policy changes within H.R. 3164 conflict with this approach to healthcare delivery and could result in patients forgoing holistic wellness exams, comprehensive preventive care, early diagnosis and optimal therapy, which could have devastating long-term consequences.”
The bill is a reintroduction of similar legislation from the last Congress, which failed to advance. Though some revisions have been made, physician groups maintain it presents the same risks as before—expanding Medicare payment for pharmacists in ways they believe could undermine comprehensive, physician-led care.