Douglas Huynh, JD, Director, Congressional Affairs, APhA
After months of anticipation, the House Ways and Means Committee recently held a markup of H.R. 3164—The Main Street Pharmacy Access Act (formerly known as ECAPS)—which passed by a voice vote. While there were a handful of amendments offered, they were either withdrawn or voted down. The discussion of the bill during the markup was largely positive, and even supported by the committee’s lone physician, Greg Murphy, MD (R-NC). The bill, as you know, provides for Part B reimbursement for the testing and treatment of various common upper respiratory illnesses, including strep, COVID-19, influenza, and respiratory syncytial virus. While it would not provide broad Part B reimbursement for all pharmacists' services, it is a significant step forward in recognizing pharmacists as true Part B providers.
The markup of the bill was one of many steps needed to ensure that the legislation went through what is known as “regular order” in Congress. Although not mandated by law, the process of regular order is considered a traditional process that the House and Senate both undertake to ensure that there are no hiccups with legislation as it is moves along for further consideration.
Having checked off an earlier box when the committee held a hearing on ECAPS last November, the next crucial step in the process was to hold a committee markup, which allows committee members to discuss the bill and make amendments/edits as needed. The May 21, 2026, markup did not garner any substantive opposition or changes, paving the way for ECAPS to be considered for further action down the line.
Considerable progress has been made but the path forward for ECAPS to become law does not include a stand-alone option. Congress typically passes 8% to 10% of stand-alone bills each year. Last year Congress reached an all-time low when less than 3% of the bills introduced made it into law. As such, the path forward for ECAPS involves incorporating it into a larger vehicle, which can carry the legislation.
It is widely expected that an end-of-year health care package will be introduced this December although it is still a bit early to definitively know. Whether or not ECAPS makes it into that package involves a number of moving pieces. What helps, however, is that the legislation has gone through regular order so that leaders on both sides of the aisle can feel more comfortable supporting the bill. It’s no secret that broad support is vital before committee leaders even consider moving a bill forward, which is why following the protocol is so important. Simply put, Congress likes to check boxes before they include any sort of legislation into a package. They are not in the business of “air dropping” policy.
So, what’s next? At this point, we wait. Often times, major legislative action spurs further action by the other committees of jurisdiction. In this case, the House Energy and Commerce committee and the Senate Finance Committee, both with jurisdiction over ECAPS, have the opportunity to act. On the House side, based on regular order, the Energy and Commerce Committee would likely hold a hearing on the issue, followed by a markup of their own. While APhA has been engaged in conversations with the Committee, we have not been notified that a hearing may be imminent. The Senate rarely holds markups, so regular order from the Senate typically entails committee leadership and their staff coordinating to discuss which bills would be up for consideration.
With June fast approaching and legislative days becoming fewer and fewer, we should learn about the fate of ECAPS sooner rather than later. But based on what has transpired over the past 48 hours and the strong support from Congressional leadership, things are certainly looking up.