119-hr2484

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2484 Introduced in House

    (IH) ]

<DOC>

119th CONGRESS
 1st Session
 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 prescription drugs furnished by a physician practice under 
 the Medicare program.

_______________________________________________________________________

 IN THE HOUSE OF REPRESENTATIVES

 March 31, 2025

 Mrs. Harshbarger (for herself, Ms. Wasserman Schultz, Mrs. Miller of 
West Virginia, Mr. Soto, Mr. Crenshaw, and Mr. Davis of North Carolina) 
 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 
 jurisdiction 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 physician practice under 
 the Medicare program.

 Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

 This Act may be cited as the ``Seniors' Access to Critical 
Medications Act of 2025''.

SEC. 2. ESTABLISHING AN EXCEPTION TO THE PHYSICIAN SELF-REFERRAL 
 PROHIBITION FOR CERTAIN OUTPATIENT PRESCRIPTION DRUGS 
 FURNISHED BY A PHYSICIAN PRACTICE UNDER THE MEDICARE 
 PROGRAM.

    (a) In General.--

Section 1877

    (b) of the Social Security Act (42 
U.S.C. 1395nn

    (b) ) is amended by adding at the end the following new 
paragraph:
 ``

    (6) Certain outpatient prescription drugs.--
 ``
        (A) In general.--In the case of designated health 
 services described in subsection

    (h)

    (6)
        (J) that are 
 covered part D drugs (as defined in 

section 1860D-2

    (e) ) 
 and furnished to an individual during the period 
 beginning on January 1, 2026, and ending on December 
 31, 2030, if--
 ``
            (i) such drugs are prescribed by the 
 referring physician (or by another physician or 
 practitioner (as described in 

section 1842

    (b)

    (18)
            (C) ) within the same group practice 
 as such physician);
 ``
            (ii) such individual has an ongoing 
 relationship (as defined by the Secretary) with 
 such physician or practitioner who prescribed 
 such drugs (or with another physician or 
 practitioner within the same group practice as 
 such physician or practitioner);
 ``
            (iii) within the 1-year period prior to 
 the dispensing of such drugs, such individual 
 had at least 1 face-to-face, in-person 
 encounter with such referring physician (or 
 with another physician or practitioner within 
 the same group practice as such physician, as 
 determined by tax identification number) during 
 which items or services that are not designated 
 health services and for which payment was made 
 under this title were furnished to such 
 individual;
 ``
            (iv) such drugs are dispensed by the 
 referring physician, a physician who is a 
 member of the same group practice as the 
 referring physician, or an individual who is 
 directly supervised by such a physician, from a 
 building described in paragraph

    (2)
        (A)
            (ii) , 
 including through--
 ``
            (I) in-person pickup by the 
 individual or a caregiver or family 
 member of such individual; or
 ``
            (II) a mail, delivery, or courier 
 service; and
 ``
            (v) such drugs are billed for by the 
 physician dispensing or supervising the 
 dispensing of such drugs, by a group practice 
 of which such physician is a member under a 
 billing number assigned to such group practice, 
 or by an entity that is wholly owned by such 
 physician or such group practice.
 ``
        (B) Rule of construction.--Nothing in 
 subparagraph
        (A) shall be construed as modifying any 
 program requirements under part D.''.

    (b) GAO Study and Report.--

    (1) Study.--The Comptroller General of the United States 
 (in this section referred to as the ``Comptroller General'') 
 shall conduct a study examining--
        (A) pharmacies or pharmacy networks participating 
 under part D of title XVIII of the Social Security Act 
 (42 U.S.C. 1395w-101 et seq.) that, after the date of 
 the enactment of this section, dispense significantly 
 more (as determined by the Comptroller General) covered 
 part D drugs (as defined in 

section 1860D-2 of such Act 
 (42 U.S.C. 1395e-102)) compared to the amount of such 
 drugs dispensed prior to such date;
        (B) common characteristics of the pharmacies and 
 pharmacy networks identified under subparagraph
        (A) , 
 including, to the extent identifiable, the extent to 
 which such pharmacies and pharmacy networks are owned 
 by a physician or group practice (as defined in 

section 1877

    (h) of the Social Security Act (42 U.S.C. 
 1395nn

    (h) ) or otherwise integrated into a physician's 
 practice or group practice; and
            (C) common characteristics of arrangements entered 
 into by physicians or group practices for purposes of 
 dispensing drugs within physicians' offices or 
 otherwise integrating pharmacies or the dispensing of 
 drugs into a physician's practice or group practice, 
 including, to the extent feasible and identifiable, an 
 analysis of--
            (i) specific physician specialties or 
 subspecialties for which such arrangements are 
 especially common or have shown substantial 
 growth;
            (ii) the extent to which physicians and 
 group practices participating in such 
 arrangements have such arrangements or 
 integration with other physicians or group 
 practices or other drug supply chain 
 participants (including pharmacy benefit 
 managers, insurers, wholesalers, distributors, 
 or management services organizations);
            (iii) common contracting features of such 
 arrangements relating to the utilization of 
 covered part D drugs or services provided in 
 connection with such drugs, including contract 
 terms related to administrative or dispensing 
 fees for such drugs and the types of payments 
 provided in connection with such services;
            (iv) common measures, including notices or 
 disclosures, taken by physicians and group 
 practices participating in such arrangements in 
 order to mitigate or otherwise address 
 potential conflicts of interest posed by such 
 arrangements; and
            (v) any components or features of such 
 arrangements that may influence prescribing 
 decisions or patterns among physicians and 
 group practices participating in such 
 arrangements.

    (2) Report.--Not later than 3 years after the date of the 
 enactment of this section, the Comptroller General shall submit 
 to Congress a report on the findings of the study required 
 under paragraph

    (1) , which shall not include identifying or 
 proprietary information with respect to the pharmacies or 
 pharmacy networks examined.

SEC. 3. MEDICARE IMPROVEMENT FUND.

 

Section 1898

    (b)

    (1) of the Social Security Act (42 U.S.C. 
1395iii

    (b)

    (1) ) is amended by striking ``1,804,000,000'' and inserting 
``1,786,000,000''.
 <all>