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[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>
Introduced in House
Introduced in House
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.
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.
Committee Consideration and Mark-up Session Held
Ordered to be Reported by the Yeas and Nays: 38 - 7.
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