The "Seniors Access to Critical Medications Act of 2025" allows physicians to dispense certain outpatient prescription drugs to Medicare patients under specific conditions, while also mandating a study on pharmacy dispensing trends and adjusting the Medicare Improvement Fund.
Diana Harshbarger
Representative
TN-1
The "Seniors Access to Critical Medications Act of 2025" allows physicians to dispense certain outpatient prescription drugs under Medicare without violating self-referral prohibitions, provided specific conditions are met, such as an existing patient relationship and in-person dispensing. It also mandates a study on pharmacies and networks with significant increases in drug dispensing, focusing on physician ownership and prescribing influences. Finally, it reduces the funding for the Medicare Improvement Fund.
Bill Proposes Allowing Doctors to Dispense Medicare Drugs Directly from 2026-2030
This bill, the Seniors’ Access to Critical Medications Act of 2025, proposes a significant change to how some Medicare patients might get their prescriptions. It creates a temporary exception – running from January 1, 2026, through December 31, 2030 – to the rules that usually prevent doctors from dispensing medications they prescribe if they have a financial stake.
Your Doc's Office as a Pharmacy?
Here’s the core idea: Under this bill (Section 2), if you're on Medicare Part D, your doctor (or someone in their practice) could dispense certain prescription drugs directly to you. This bypasses the usual trip to a separate pharmacy. Think of the convenience – potentially getting your medication right after your appointment.
There are strings attached, though. This exception only applies if:
- You have an ongoing relationship with the prescribing doctor (or someone else in the practice).
- You've seen that doctor face-to-face within the last year for something other than just getting the prescription.
- The meds are dispensed directly by the doctor, their practice member, or supervised staff, either via in-person pickup, mail, or delivery.
This directly alters the physician self-referral prohibition (often called the Stark Law), which generally aims to prevent conflicts of interest where doctors might profit from referring patients to services they own. This bill carves out a specific, time-limited exception for dispensing certain Part D drugs.
Watching for Conflicts: The Built-In Study
Because letting doctors dispense the drugs they prescribe raises obvious questions about financial incentives potentially influencing medical decisions, the bill includes a safeguard (Section 2). It requires the Comptroller General (the government's main auditor) to study pharmacies and networks that significantly increase their dispensing after this change takes effect, paying close attention to physician ownership or integration.
The study will dig into:
- How doctors are arranging to dispense drugs.
- Which medical specialties are most involved.
- Whether safeguards are in place to manage conflicts of interest.
- Any signs that prescribing decisions are being influenced.
A report on these findings is due to Congress within three years, aiming to provide data on whether this new convenience comes at the cost of objective medical care.
A Small Trim to Medicare Funds
Lastly, the bill makes a small adjustment to the Medicare Improvement Fund (Section 3). It reduces the available funds by $18 million, from $1.804 billion down to $1.786 billion. This fund is generally used for various improvements within the Medicare system, so this reduction means slightly less money is available for other potential initiatives.