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Seniors’ Access to Critical Medications Act of 2025

USA119th CongressHR-2484| House 
| Updated: 4/29/2025
Diana Harshbarger

Diana Harshbarger

Republican Representative

Tennessee

Cosponsors (24)
Jared F. Golden (Democratic)Tim Burchett (Republican)Darren Soto (Democratic)Mariannette Miller-Meeks (Republican)Terri A. Sewell (Democratic)Aaron Bean (Republican)Donald G. Davis (Democratic)Nathaniel Moran (Republican)Michael A. Rulli (Republican)Gus M. Bilirakis (Republican)Carol D. Miller (Republican)Joe Wilson (Republican)Mike Kelly (Republican)Richard Hudson (Republican)Raja Krishnamoorthi (Democratic)Ron Estes (Republican)W. Gregory Steube (Republican)Josh Riley (Democratic)Dan Crenshaw (Republican)Josh Gottheimer (Democratic)Debbie Wasserman Schultz (Democratic)Troy Balderson (Republican)Chellie Pingree (Democratic)Nicole Malliotakis (Republican)

Ways and Means Committee, Energy and Commerce Committee

  • Introduced
  • In Committee
  • On Floor
  • Passed Chamber
  • Enacted
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.
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Timeline

Bill from Previous Congress

HR 118-5526
Seniors’ Access to Critical Medications Act of 2024
Mar 31, 2025
Introduced in House
Mar 31, 2025
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.
Apr 29, 2025
Committee Consideration and Mark-up Session Held
Apr 29, 2025
Ordered to be Reported by the Yeas and Nays: 38 - 7.
  • Bill from Previous Congress

    HR 118-5526
    Seniors’ Access to Critical Medications Act of 2024


  • March 31, 2025
    Introduced in House


  • March 31, 2025
    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.


  • April 29, 2025
    Committee Consideration and Mark-up Session Held


  • April 29, 2025
    Ordered to be Reported by the Yeas and Nays: 38 - 7.

Health

Congressional oversightGovernment studies and investigationsHealth personnelMedicarePrescription drugs

Seniors’ Access to Critical Medications Act of 2025

USA119th CongressHR-2484| House 
| Updated: 4/29/2025
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.
View Full Text

Suggested Questions

Get AI-generated questions to help you understand this bill better

Timeline

Bill from Previous Congress

HR 118-5526
Seniors’ Access to Critical Medications Act of 2024
Mar 31, 2025
Introduced in House
Mar 31, 2025
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.
Apr 29, 2025
Committee Consideration and Mark-up Session Held
Apr 29, 2025
Ordered to be Reported by the Yeas and Nays: 38 - 7.
  • Bill from Previous Congress

    HR 118-5526
    Seniors’ Access to Critical Medications Act of 2024


  • March 31, 2025
    Introduced in House


  • March 31, 2025
    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.


  • April 29, 2025
    Committee Consideration and Mark-up Session Held


  • April 29, 2025
    Ordered to be Reported by the Yeas and Nays: 38 - 7.
Diana Harshbarger

Diana Harshbarger

Republican Representative

Tennessee

Cosponsors (24)
Jared F. Golden (Democratic)Tim Burchett (Republican)Darren Soto (Democratic)Mariannette Miller-Meeks (Republican)Terri A. Sewell (Democratic)Aaron Bean (Republican)Donald G. Davis (Democratic)Nathaniel Moran (Republican)Michael A. Rulli (Republican)Gus M. Bilirakis (Republican)Carol D. Miller (Republican)Joe Wilson (Republican)Mike Kelly (Republican)Richard Hudson (Republican)Raja Krishnamoorthi (Democratic)Ron Estes (Republican)W. Gregory Steube (Republican)Josh Riley (Democratic)Dan Crenshaw (Republican)Josh Gottheimer (Democratic)Debbie Wasserman Schultz (Democratic)Troy Balderson (Republican)Chellie Pingree (Democratic)Nicole Malliotakis (Republican)

Ways and Means Committee, Energy and Commerce Committee

Health

  • Introduced
  • In Committee
  • On Floor
  • Passed Chamber
  • Enacted
Congressional oversightGovernment studies and investigationsHealth personnelMedicarePrescription drugs