On guard against scope expansions and patient safety risks at the federal level, the Texas Medical Association joined the American Medical Association and nearly 100 other national and state organizations to oppose granting pharmacists the ability to test for and treat certain respiratory illnesses under Medicare, as proposed in a pair of House and Senate bills.
Both dubbed the Equitable Community Access to Pharmacist Services (ECAPS) Act, H.R. 3164 and S. 2426 would allow Medicare reimbursement for pharmacists to perform evaluation and management services for influenza, COVID-19, respiratory syncytial virus (RSV), and streptococcal pharyngitis (strep throat). Similar legislation considered by the 2025 Texas Legislature eventually died.
“On the surface, the three words ‘test and treat’ sound relatively simple and innocuous, but when you dig a little more deeply, there are a lot of cons,” said Zeke Silva, MD, chair of TMA’s Council on Legislation. “Considerable clinical decision-making that goes into those three words.”
In a pair of letters to the House and Senate bills’ respective authors, medicine acknowledged pharmacists play an important role in physician-led, team-based health care, but criticized the legislation for “inappropriately allowing pharmacists to perform services that ... constitute the practice of medicine and fall well beyond the scope of training of a pharmacist,” namely performing examinations, diagnosing patients, or formulating treatment plans.
Cautioning against potential patient harms, the signatories warned the diagnoses allowed under the legislation “would be guided by the results of a CLIA-waived test, but this is problematic because the results of a test alone are not enough to make a conclusive diagnosis or to rule out other complications.
“For example, physicians are trained in residency to identify a serious illness, such as a respiratory disease, and to perform differential diagnoses; pharmacists simply are not. Without a comprehensive physical exam by a trained professional done in the full context of the patient’s health, the severity of an illness is easily under-appreciated, and the underlying causes of symptoms may be overlooked.”
They also questioned the bills’ lack of meaningful physician involvement in so-called collaborative practice agreements and pointed to concerning surveys showing 95% of U.S. voters consider it important for a physician to be involved in diagnosis and treatment decisions and a majority of pharmacists themselves report “excessively high” workloads.
As of this writing, H.R. 3164 and S. 2426 were pending in their chambers’ respective committees.
Learn more about TMA’s federal advocacy efforts on scope of practice and other pressing topics.
Phil West
Associate Editor
(512) 370-1394
phil.west[at]texmed[dot]org
Phil West is a writer and editor whose publications include the Los Angeles Times, Seattle Times, Austin American-Statesman, and San Antonio Express-News. He earned a BA in journalism from the University of Washington and an MFA from the University of Texas at Austin’s James A. Michener Center for Writers. He lives in Austin with his wife, children, and a trio of free-spirited dogs.