H.R. 2484: Seniors’ Access to Critical Medications Act of 2025

This bill, titled the **Seniors’ Access to Critical Medications Act of 2025**, seeks to amend the Social Security Act to allow exceptions to existing rules regarding physician self-referral, specifically related to outpatient prescription drugs provided through Medicare.

Key Provisions

The bill establishes new rules for how certain outpatient prescription drugs can be prescribed and dispensed by physicians within specified parameters. Key elements include:

• Eligibility of Prescription Drugs: The provisions apply to designated health services that are covered under Medicare Part D, specifically drugs prescribed and dispensed between January 1, 2026, and December 31, 2030.
• Referral Conditions: Physicians can prescribe these medications provided:
  • The patient has an ongoing relationship with the prescribing physician or another physician in the same practice.
  • The patient has had an in-person visit with the prescribing physician or another member of the practice in the year prior to receiving the drugs.
  • The drugs are dispensed from a location that meets specific requirements and can be picked up in person, or delivered through a service.
  • Billing for the drugs must occur through the physician or their practice, following regulation and oversight standards.

GAO Study and Report

The bill requires the Comptroller General of the United States to conduct a study on pharmacies that dispense Medicare Part D drugs. This study aims to:

• Identify pharmacies that dispense significantly more covered drugs after this legislation is enacted compared to before.
• Examine characteristics of these pharmacies, particularly regarding ownership by physicians or their practices.
• Analyze arrangements for drug dispensing within physician offices and their integration with pharmacies.
• Evaluate potential conflicts of interest associated with physicians dispensing drugs and the impact on prescribing behavior.

A report with the findings from this study must be submitted to Congress within three years, ensuring that identifying information related to pharmacies remains confidential.

Adjustment to Medicare Improvement Fund

Lastly, the bill makes a minor adjustment to the **Medicare improvement fund** by changing the funding amount from **$1.804 billion** to **$1.786 billion**. This change is part of the broader funding structure for Medicare, although it is not a primary focus of the bill.

Relevant Companies