Seniors’ Access to Critical Medications Act of 2025

This legislation creates a temporary exception to the physician self-referral prohibition under the Medicare program, specifically for certain outpatient prescription drugs covered by Medicare Part D. This allows physicians to dispense these medications directly from their practice, aiming to improve patient access to critical drugs. The exception is slated to be in effect for a five-year period, from January 1, 2026, through December 31, 2030. To qualify for this exception, several stringent conditions must be satisfied. The drugs must be prescribed by the referring physician or another practitioner within the same group practice, and the patient must have an ongoing relationship with that prescribing physician or practice. Additionally, the patient must have had at least one face-to-face, in-person encounter with the physician or practice within the year prior to dispensing, for services not considered designated health services. Dispensing can occur through in-person pickup or via mail, delivery, or courier service from the physician's office, with billing handled by the dispensing physician or their group practice. Beyond establishing this exception, the bill mandates a Government Accountability Office (GAO) study to examine pharmacies that significantly increase their dispensing of Part D drugs and their integration with physician practices. This study will analyze common characteristics and arrangements, including potential conflicts of interest and influences on prescribing patterns, with a report due to Congress within three years. Finally, the bill also includes a provision to adjust the Medicare Improvement Fund by reducing the allocated amount.