Medicare carve-out lets doctors profit from drug sales to seniors
H.R. 2484 — Seniors’ Access to Critical Medications Act of 2025 · Filed by Diana Harshbarger (R-TN) · 26 cosponsors · Introduced Mar 31, 2025 · Reported out
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What it does
This bill creates a narrow exception to the federal physician self-referral prohibition (Stark Law) that allows doctors and physician practices to dispense and bill for certain prescription drugs directly to Medicare patients from January 2026 through December 2030, provided the patient has an ongoing relationship with the prescribing physician and at least one in-person visit in the prior year. The bill benefits physician practices by allowing them to capture pharmacy revenue and margins on drug dispensing, while requiring the GAO to study whether this arrangement influences prescribing patterns or creates conflicts of interest.
Why we flagged it
The bill's operative mechanism is a narrow exception to the Stark Law's conflict-of-interest prohibition, allowing physicians to profit from drug dispensing. The 'Seniors' Access' framing masks a financial incentive structure that benefits physician practices, not patients.
What the text implies
- The 5-year window (2026–2030) creates urgency for physician practices to establish in-office dispensing infrastructure before the exception expires, potentially locking in prescribing patterns and patient dependencies.
- The 'ongoing relationship' and 'face-to-face encounter' requirements are low barriers—a single annual visit satisfies the condition, making it easy for physicians to justify dispensing to nearly all their patients.
The full analysis lists 5 implications of this text.
Who stands to gain
physician practices and group practices; physician-owned pharmacies; physician-owned drug dispensing entities