I
119THCONGRESS
1
STSESSION H. R. 2484
To amend title XVIII of the Social Security Act to establish an exception
to the physician self-referral prohibition for certain outpatient prescrip-
tion drugs furnished by a physician practice under the Medicare program.
IN THE HOUSE OF REPRESENTATIVES
MARCH31, 2025
Mrs. H
ARSHBARGER(for herself, Ms. WASSERMANSCHULTZ, Mrs. MILLERof
West Virginia, Mr. S
OTO, Mr. CRENSHAW, and Mr. DAVISof North Caro-
lina) 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 juris-
diction 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 phy-
sician practice under the Medicare program.
Be it enacted by the Senate and House of Representa-1
tives of the United States of America in Congress assembled, 2
SECTION 1. SHORT TITLE. 3
This Act may be cited as the ‘‘Seniors’ Access to Crit-4
ical Medications Act of 2025’’. 5
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SEC. 2. ESTABLISHING AN EXCEPTION TO THE PHYSICIAN 1
SELF-REFERRAL PROHIBITION FOR CERTAIN 2
OUTPATIENT PRESCRIPTION DRUGS FUR-3
NISHED BY A PHYSICIAN PRACTICE UNDER 4
THE MEDICARE PROGRAM. 5
(a) I
NGENERAL.—Section 1877(b) of the Social Se-6
curity Act (42 U.S.C. 1395nn(b)) is amended by adding 7
at the end the following new paragraph: 8
‘‘(6) C
ERTAIN OUTPATIENT PRESCRIPTION 9
DRUGS.— 10
‘‘(A) I
N GENERAL.—In the case of des-11
ignated health services described in subsection 12
(h)(6)(J) that are covered part D drugs (as de-13
fined in section 1860D–2(e)) and furnished to 14
an individual during the period beginning on 15
January 1, 2026, and ending on December 31, 16
2030, if— 17
‘‘(i) such drugs are prescribed by the 18
referring physician (or by another physi-19
cian or practitioner (as described in section 20
1842(b)(18)(C)) within the same group 21
practice as such physician); 22
‘‘(ii) such individual has an ongoing 23
relationship (as defined by the Secretary) 24
with such physician or practitioner who 25
prescribed such drugs (or with another 26
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physician or practitioner within the same 1
group practice as such physician or practi-2
tioner); 3
‘‘(iii) within the 1-year period prior to 4
the dispensing of such drugs, such indi-5
vidual had at least 1 face-to-face, in-person 6
encounter with such referring physician (or 7
with another physician or practitioner 8
within the same group practice as such 9
physician, as determined by tax identifica-10
tion number) during which items or serv-11
ices that are not designated health services 12
and for which payment was made under 13
this title were furnished to such individual; 14
‘‘(iv) such drugs are dispensed by the 15
referring physician, a physician who is a 16
member of the same group practice as the 17
referring physician, or an individual who is 18
directly supervised by such a physician, 19
from a building described in paragraph 20
(2)(A)(ii), including through— 21
‘‘(I) in-person pickup by the indi-22
vidual or a caregiver or family mem-23
ber of such individual; or 24
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‘‘(II) a mail, delivery, or courier 1
service; and 2
‘‘(v) such drugs are billed for by the 3
physician dispensing or supervising the dis-4
pensing of such drugs, by a group practice 5
of which such physician is a member under 6
a billing number assigned to such group 7
practice, or by an entity that is wholly 8
owned by such physician or such group 9
practice. 10
‘‘(B) R
ULE OF CONSTRUCTION .—Nothing 11
in subparagraph (A) shall be construed as 12
modifying any program requirements under 13
part D.’’. 14
(b) GAO S
TUDY ANDREPORT.— 15
(1) S
TUDY.—The Comptroller General of the 16
United States (in this section referred to as the 17
‘‘Comptroller General’’) shall conduct a study exam-18
ining— 19
(A) pharmacies or pharmacy networks par-20
ticipating under part D of title XVIII of the 21
Social Security Act (42 U.S.C. 1395w–101 et 22
seq.) that, after the date of the enactment of 23
this section, dispense significantly more (as de-24
termined by the Comptroller General) covered 25
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part D drugs (as defined in section 1860D–2 of 1
such Act (42 U.S.C. 1395e–102)) compared to 2
the amount of such drugs dispensed prior to 3
such date; 4
(B) common characteristics of the phar-5
macies and pharmacy networks identified under 6
subparagraph (A), including, to the extent iden-7
tifiable, the extent to which such pharmacies 8
and pharmacy networks are owned by a physi-9
cian or group practice (as defined in section 10
1877(h) of the Social Security Act (42 U.S.C. 11
1395nn(h)) or otherwise integrated into a phy-12
sician’s practice or group practice; and 13
(C) common characteristics of arrange-14
ments entered into by physicians or group prac-15
tices for purposes of dispensing drugs within 16
physicians’ offices or otherwise integrating 17
pharmacies or the dispensing of drugs into a 18
physician’s practice or group practice, includ-19
ing, to the extent feasible and identifiable, an 20
analysis of— 21
(i) specific physician specialties or 22
subspecialties for which such arrangements 23
are especially common or have shown sub-24
stantial growth; 25
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(ii) the extent to which physicians and 1
group practices participating in such ar-2
rangements have such arrangements or in-3
tegration with other physicians or group 4
practices or other drug supply chain par-5
ticipants (including pharmacy benefit man-6
agers, insurers, wholesalers, distributors, 7
or management services organizations); 8
(iii) common contracting features of 9
such arrangements relating to the utiliza-10
tion of covered part D drugs or services 11
provided in connection with such drugs, in-12
cluding contract terms related to adminis-13
trative or dispensing fees for such drugs 14
and the types of payments provided in con-15
nection with such services; 16
(iv) common measures, including no-17
tices or disclosures, taken by physicians 18
and group practices participating in such 19
arrangements in order to mitigate or oth-20
erwise address potential conflicts of inter-21
est posed by such arrangements; and 22
(v) any components or features of 23
such arrangements that may influence pre-24
scribing decisions or patterns among physi-25
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cians and group practices participating in 1
such arrangements. 2
(2) R
EPORT.—Not later than 3 years after the 3
date of the enactment of this section, the Comp-4
troller General shall submit to Congress a report on 5
the findings of the study required under paragraph 6
(1), which shall not include identifying or propri-7
etary information with respect to the pharmacies or 8
pharmacy networks examined. 9
SEC. 3. MEDICARE IMPROVEMENT FUND. 10
Section 1898(b)(1) of the Social Security Act (42 11
U.S.C. 1395iii(b)(1)) is amended by striking 12
‘‘1,804,000,000’’ and inserting ‘‘1,786,000,000’’. 13
Æ
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