HR 2484119th CongressIntroduced

Seniors’ Access to Critical Medications Act of 2025

Introduced: Mar 31, 2025

Standard Summary

Comprehensive overview in 1-2 paragraphs

Seniors’ Access to Critical Medications Act of 2025 would create a temporary exception to the physician self-referral (Stark) prohibition for certain outpatient prescription drugs that are dispensed by a physician practice under Medicare. The exception would apply from January 1, 2026 through December 31, 2030 and would cover Part D drugs that meet specific conditions, including who prescribes, how the patient–physician relationship is established, and how the drugs are dispensed and billed. The bill also requires a Government Accountability Office (GAO) study to examine how physician-involved dispensing may affect drug supply chains and potential conflicts of interest, and it would adjust a Medicare Improvement Fund appropriation downward by $18 million. The intent appears to be to improve seniors’ access to certain medications by allowing on-site or closely integrated dispensing, while adding oversight to monitor for conflicts of interest and other risks.

Key Points

1Temporary exception to Stark self-referral for certain outpatient prescription drugs
2- Applies to designated health services described in the Medicare statute that are Part D-covered drugs, dispensed from Jan 1, 2026 to Dec 31, 2030.
3- Eligible if prescribed by the referring physician or another physician/practitioner within the same group practice, and if the patient has an ongoing relationship with that physician or group.
4- Requires a prior in-person encounter within the previous year (with non-designated health services paid under Medicare) and allows dispensing either in-person at the physician’s building or via mail/delivery, under supervision.
5- Billing for these drugs must be done by the dispensing physician, a physician in the same group, or an entity wholly owned by the physician or group, under the group practice’s billing number.
6- A rule of construction states this does not modify Part D program requirements.
7GAO study and reporting requirement
8- The Comptroller General must study pharmacies/pharmacy networks that dispense significantly more Part D drugs after enactment, characteristics of these pharmacies/networks (including physician ownership or integration), and the contract features and potential conflicts of interest involved in such arrangements.
9- The GAO must issue a report within 3 years of enactment, excluding identifying or proprietary information.
10Budgetary change
11- The Medicare Improvement Fund appropriation is reduced from 1,804,000,000 to 1,786,000,000 (a reduction of 18,000,000).

Impact Areas

Primary group/area affected- Medicare beneficiaries, particularly seniors who rely on Part D drugs and may benefit from receiving certain medications directly through a physician practice (through in-office dispensing or related arrangements) during the 2026–2030 window.Secondary group/area affected- Physicians and physician practices that operate dispensing activities or are part of group practices, and the entities billing for these drugs.- Pharmacy networks and pharmacies involved in Part D drug distribution, especially those inside or closely aligned with physician practices.- Medicare Part D plans, sponsors, and administrators who coordinate the coverage and payment for these drugs.Additional impacts- Potential changes in access to medications (faster or more convenient dispensing for some patients) vs. risks related to conflicts of interest and prescribing behavior.- Increased oversight and data collection via the GAO study, with implications for policy and potential future reforms depending on findings.- A modest impact on federal budgeting through the reduction in the Medicare Improvement Fund appropriation.

Generated by gpt-5-nano on Nov 19, 2025