Perspectives on Diabetes Care

Improving Access to Diabetes Care by Granting Medicare Provider Status to Pharmacists

Sep 17, 2026, 15:54 PM

By: Linda Gutierrez-Miller PharmD, Helen Pervanas PharmD

Currently, pharmacists are not recognized as providers by Medicare Part B, which covers outpatient services and durable medical equipment (DME) such as blood glucose test strips and continuous glucose monitors (CGMs).¹ Because pharmacists are not recognized as providers, Medicare Part B will not provide reimbursement for pharmacist office visits or DME prescribed by a pharmacist. However, many state Medicaid and commercial insurance plans recognize pharmacists as providers, allowing for these reimbursements.

Pharmacists are one of the most accessible healthcare professionals.² To become a pharmacist, students today in the United States graduate from doctoral degree programs. Pharmacists prevent drug interactions and adverse medical events. Studies show that they help lower hemoglobin A1C, blood pressure, LDL-C, and BMI. They also improve medication-taking and lower healthcare costs. ^3,4

Pharmacists have the knowledge to treat Medicare beneficiaries with diabetes. Some pharmacists are certified diabetes care and education specialists (CDCES) and have the board certified-advanced diabetes management (BC-ADM) credential. Pharmacists with a collaborative practice agreement are prescribing diabetes medications, CGMs, and insulin pumps and they are educating patients on how to use these medications and technologies to improve diabetes management.

Medicare Population and Physician Shortage

In 2025, around 69 million people were enrolled in Medicare.⁵ Around 30% of those 65 years and older are estimated to have diabetes.⁶ This is a large population that pharmacists could serve better if recognized as providers by Medicare.

The Association of American Medical Colleges acknowledges the national shortage of physicians and estimates this shortage to reach 86,000 by 2036.⁷ Patients are having difficulty finding providers to treat them, which pharmacists could help with if recognized as providers by Medicare. Pharmacists and pharmacy technicians today are no longer found just in pharmacies but also in provider offices where they work collaboratively to treat patients. They also assist providers with medication prior authorizations, patient assistance programs, and vaccinations. More physicians and nurse practitioners could hire pharmacists to work in their offices if pharmacists’ services were billable to Medicare Part B.

Delay in Patient Care without Medicare Provider Status for Pharmacists

In addition to a shortage of physicians making it difficult for Medicare beneficiaries to receive timely treatment for their diabetes, the current system also creates delays for filling prescriptions, particularly for supplies such as blood glucose testing supplies. Medicare has strict requirements for test strip reimbursement.  If the provider writes to use “as needed,” or “PRN,” the pharmacist must contact the provider to find out the exact number of times per day that the patient needs to test their blood sugar. The limits on the number of test strips and lancets Medicare allows creates delays in receiving blood glucose supplies. If a provider sends a prescription for their Medicare patient who is not on insulin to test blood glucose twice a day for 3 months, the prescription cannot be filled as only 100 strips are allowed for 90 days. ⁸ The pharmacist must reach out to the provider for a new prescription that meets Medicare requirements.  Clarification of prescriptions takes time away from both the provider and pharmacist resulting in delays in patient care. For the person having hypoglycemia symptoms, getting access to that test strip may prevent an emergency room visit. If pharmacists were recognized Medicare providers, they could prescribe and dispense test strips right away instead of waiting days or sometimes weeks for clarification.

Five Things to Know About Pharmacist Provider Status and Why it Matters

1. Pharmacists are not recognized by Medicare Part B as providers        
   • Allowing pharmacists Medicare provider status would let them bill directly for DSMT
2. Many reforms are occurring at the state level        
   • State action can serve as a blueprint for Medicare
3. Collaborative Practice Agreements are widespread          
   • Allows pharmacists to manage medications and chronic medical conditions
4. Pharmacist provider status can improve patient outcomes             
   • Expands access to care and reduces healthcare costs
5. National shortage of physicians      
   • Pharmacists can assist by providing clinical services

Diabetes Self-Management Training

Diabetes Self-Management Training (DSMT) is another service reimbursed by Medicare. Only about 5% of Medicare recipients with newly diagnosed diabetes use DSMT.⁹ Pharmacists cannot bill Medicare for DSMT directly because they are not recognized providers. Instead, if the pharmacist is employed by a pharmacy that is a Medicare Part B supplier, then the pharmacy can bill CMS. However, not all pharmacists are employed by a pharmacy. Giving Medicare provider status to pharmacists would let them bill directly for DSMT, giving people with diabetes more options for accessing DSMT and improving utilization rates.²

Pharmacy and Medically Underserved Areas Enhancement Act

The Pharmacy and Medically Underserved Areas Enhancement Act is a bill that would allow pharmacists to have Medicare Part B provider status in medically underserved areas.¹⁰ The bill has been under consideration since 2015 but has yet to pass. Giving pharmacists Medicare Part B provider status would improve access to diabetes care.

In addition to federal initiatives, there were 242 bills that were introduced in 49 states during the 2025 legislative session to expand the scope of practice and/or payment for services for pharmacists.¹¹ To improve health access and counteract provider shortages, Missouri and North Dakota passed laws that allow pharmacists to be reimbursed for clinical services by commercial and state Medicaid programs and significantly advanced the pharmacist’s role in patient care.^12,13

The continued expansion of pharmacist provider status represents a major shift in healthcare delivery. States increasingly recognize pharmacists as accessible clinicians capable of improving outcomes, expanding preventive care, and reducing healthcare costs. Federal recognition is a critical step to achieving nationwide reimbursement and sustainable integration of pharmacists into multidisciplinary patient care teams.

Action Items to support pharmacist provider status

1. Contact state legislators to support bills recognizing pharmacists as providers:
2. Join national and state campaigns to advocate on behalf of pharmacist provider status.
3. Educate patients and other healthcare professionals on the importance of pharmacist provider status and healthcare accessibility.
   

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References

1. Medicare.Gov. What part B covers.  https://www.medicare.gov/providers-services/original-medicare/part-b. Accessed May 25, 2026.
2. Advanced Study. Are pharmacists one of the most accessible healthcare professionals? https://advancestudy.org/are-pharmacists-one-of-the-most-accessible-healthcare-professionals/#google_vignette. Accessed May 25, 2026.
3. Zhang L, Lin H, Wu W, et al. A meta-analysis of the impact of pharmacist interventions on clinical outcomes in patients with type-2 diabetes. Patient Educ. Couns [serial online].2025;120:108091. https://doi.org/10.1016/j.pec.2023.108091.  Accessed June 14, 2026.
4. Wu WC, Taveira TH, Jeffery S, et. al. Cost and effectiveness of pharmacist-led group medical visits for type-2 diabetes: A multi-center randomized controlled trial. PLOS One [serial online]. 2018; https://doi.org/10.1371/journal.pone.0195898. Accessed June 14, 2026.
5. SeniorLiving.org. Medicare and Medicaid statistics. A complete guide for 2025.https://www.seniorliving.org/medicare-medicaid/statistics/. Accessed May 25, 2026.
6. National Council on Aging. Diabetes and Medicare. https://www.ncoa.org/article/diabetes-and-medicare/. Accessed May 25, 2026.
7. The Global Statistics. US doctor & surgeon shortage statistics 2026.  https://www.theglobalstatistics.com/us-doctor-and-surgeon-shortage-statistics/. Accessed May 25, 2026.
8. Centers for Medicare and Medicaid. Medicare coverage of diabetes testing supplies.  https://www.cms.gov/files/document/mln7674574-medicare-coverage-diabetes-supplies.pdf. Accessed May 25, 2026.
9. Strawbridge LM, Lloyd JT, Meadow A, et al. Use of Medicare’s diabetes self-management training benefit. Health Educ. Behav. 2015; 42: 530-8.
10. Congress.gov. Pharmacy and medically underserved areas enhancement act. https://www.congress.gov/bill/114th-congress/house-bill/592?hl=Pharmacy+and+Medically+Underserved+Areas+Enhancement+Act&s=5&r=2 . Accessed June 3, 2026.
11. National Alliance of State Pharmacy Associations. 2025 Provider status end of year legislative update.  https://naspa.us/resource/2025-provider-status-end-of-year-legislative-update/ . Accessed May 27, 2026.
12. North Dakota Legislative Council. SB 2402. https://ndlegis.gov/assembly/69-2025/special/bill-overview/bo2402.html#. Accessed May 28, 2026.
13. Missouri Senate. SB 878. https://www.senate.mo.gov/BillTracking/Bills/BillInformation?year=2026&billid=276. Accessed May 28, 2026.