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Seniors’ Access to Critical Medications Act of 2025 This bill temporarily expands flexibilities under the Stark law (i.e., the Physician Self-Referral Law) for certain physicians who dispense covered outpatient drugs under the Medicare prescription drug benefit at the physician's office location (e.g., through an integrated pharmacy). The Stark law generally prohibits physicians from referring patients to receive services that are payable under Medicare or Medicaid from entities in which the physician or an immediate family member has a financial relationship. Specifically, the bill allows, from 2026-2030, physicians to dispense such drugs from the physician's office, including through in-person pickup by a caregiver or via mail, if (1) the physician prescribed the drug, (2) the beneficiary has an ongoing relationship with the physician, (3) the beneficiary had at least one face-to-face visit with the physician in the prior year, and (4) the physician bills for the drug. These requirements also apply to physicians within the same group practice. The Government Accountability Office must report on pharmacies or pharmacy networks that dispense significantly more covered drugs under the Medicare prescription drug benefit after the bill's enactment, the extent to which such pharmacies and networks are owned by physicians or integrated into physician practices, and the common characteristics of these types of arrangements.
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Full Bill Text
119 HR 2484 IH: Seniors’ Access to Critical Medications Act of 2025 U.S. House of Representatives 2025-03-31 text/xml EN Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain. I 119th CONGRESS 1st Session H. R. 2484 IN THE HOUSE OF REPRESENTATIVES March 31, 2025 Mrs. Harshbarger (for herself, Ms. Wasserman Schultz , Mrs. Miller of West Virginia , Mr. Soto , Mr. Crenshaw , and Mr. Davis of North Carolina ) introduced the following bill; which was referred to the Committee on Energy and Commerce , and in addition to the Committee on Ways and Means , for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned A BILL To amend title XVIII of the Social Security Act to establish an exception to the physician self-referral prohibition for certain outpatient prescription drugs furnished by a physician practice under the Medicare program. 1. Short title This Act may be cited as the Seniors’ Access to Critical Medications Act of 2025 . 2. Establishing an exception to the physician self-referral prohibition for certain outpatient prescription drugs furnished by a physician practice under the Medicare program (a) In general Section 1877(b) of the Social Security Act ( 42 U.S.C. 1395nn(b) ) is amended by adding at the end the following new paragraph: (6) Certain outpatient prescription drugs (A) In general In the case of designated health services described in subsection (h)(6)(J) that are covered part D drugs (as defined in section 1860D–2(e)) and furnished to an individual during the period beginning on January 1, 2026, and ending on December 31, 2030, if— (i) such drugs are prescribed by the referring physician (or by another physician or practitioner (as described in section 1842(b)(18)(C)) within the same group practice as such physician); (ii) such individual has an ongoing relationship (as defined by the Secretary) with such physician or practitioner who prescribed such drugs (or with another physician or practitioner within the same group practice as such physician or practitioner); (iii) within the 1-year period prior to the dispensing of such drugs, such individual had at least 1 face-to-face, in-person encounter with such referring physician (or with another physician or practitioner within the same group practice as such physician, as determined by tax identification number) during which items or services that are not designated health services and for which payment was made under this title were furnished to such individual; (iv) such drugs are dispensed by the referring physician, a physician who is a member of the same group practice as the referring physician, or an individual who is directly supervised by such a physician, from a building described in paragraph (2)(A)(ii), including through— (I) in-person pickup by the individual or a caregiver or family member of such individual; or (II) a mail, delivery, or courier service; and (v) such drugs are billed for by the physician dispensing or supervising the dispensing of such drugs, by a group practice of which such physician is a member under a billing number assigned to such group practice, or by an entity that is wholly owned by such physician or such group practice. (B) Rule of Construction Nothing in subparagraph (A) shall be construed as modifying any program requirements under part D. . (b) GAO study and report (1) Study The Comptroller General of the United States (in this section referred to as the Comptroller General ) shall conduct a study examining— (A) pharmacies or pharmacy networks participating under part D of title XVIII of the Social Security Act ( 42 U.S.C. 1395w–101 et seq. ) that, after the date of the enactment of this section, dispense significantly more (as determined by the Comptroller General) covered part D drugs (as defined in section 1860D–2 of such Act ( 42 U.S.C. 1395e–102 )) compared to the amount of such drugs dispensed prior to such date; (B) common characteristics of the pharmacies and pharmacy networks identified under subparagraph (A), including, to the extent identifiable, the extent to which such pharmacies and pharmacy networks are owned by a physician or group practice (as defined in section 1877(h) of the Social Security Act ( 42 U.S.C. 1395nn(h) ) or otherwise integrated into a physician’s practice or group practice; and (C) common characteristics of arrangements entered into by physicians or group practices for purposes of dispensing drugs within physicians’ offices or otherwise integrating pharmacies or the dispensing of drugs into a physician’s practice or group practice, including, to the extent feasible and identifiable, an analysis of— (i) specific physician specialties or subspecialties for which such arrangements are especially common or have shown substantial growth; (ii) the extent to which physicians and group practices participating in such arrangements have such arrangements or integration with other physicians or group practices or other drug supply chain participants (including pharmacy benefit managers, insurers, wholesalers, distributors, or management services organizations); (iii) common contracting features of such arrangements relating to the utilization of covered part D drugs or services provided in connection with such drugs, including contract terms related to administrative or dispensing fees for such drugs and the types of payments provided in connection with such services; (iv) common measures, including notices or disclosures, taken by physicians and group practices participating in such arrangements in order to mitigate or otherwise address potential conflicts of interest posed by such arrangements; and (v) any components or features of such arrangements that may influence prescribing decisions or patterns among physicians and group practices participating in such arrangements. (2) Report Not later than 3 years after the date of the enactment of this section, the Comptroller General shall submit to Congress a report on the findings of the study required under paragraph (1), which shall not include identifying or proprietary information with respect to the pharmacies or pharmacy networks examined. 3. Medicare improvement fund Section 1898(b)(1) of the Social Security Act ( 42 U.S.C. 1395iii(b)(1) ) is amended by striking 1,804,000,000 and inserting 1,786,000,000 .
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