This bill changes Medicare rules to let certain doctors and their group practices dispense some outpatient prescription drugs that are covered under Medicare Part D. The change applies from January 1, 2026 through December 31, 2030. To qualify, the drug must be prescribed by the referring doctor (or another doctor in the same group), the patient must have an ongoing relationship with that doctor as defined by the Secretary, and the patient must have had at least one face-to-face, in-person visit with the doctor (or someone in the same group) in the prior year during which non-designated health services were paid under Medicare. The drugs must be dispensed by the referring doctor, a doctor in the same group, or someone directly supervised by such a doctor, from a building specified in the statute, and may be given by in-person pickup or by mail, delivery, or courier. Billing must be done by the dispensing doctor, the group practice billing number, or an entity wholly owned by the doctor or group. The bill also says this change does not alter Part D program requirements.
The bill requires the Comptroller General (GAO) to study pharmacies or pharmacy networks that substantially increase Part D drug dispensing after the bill becomes law. The study must look at ownership, connections to physician practices, common contracting features, steps taken to address conflicts of interest, and anything that may affect prescribing patterns. The GAO must report to Congress within three years and must not include identifying or proprietary information.
Finally, the bill amends a line in the statute that reduces the Medicare Improvement Fund amount listed in current law from 1,804,000,000 to 1,786,000,000.
If you are a Medicare Part D beneficiary, the bill may allow your doctor or your doctor’s group to directly give or mail certain Part D drugs to you if the rules in the bill are met. If you are a physician or part of a group practice, the bill creates a limited exception to the physician self-referral prohibition so you may dispense covered Part D drugs under the listed conditions and billing rules between 2026 and 2030. The GAO study could provide more information to Congress about how dispensing arrangements change after the law is in effect.
No publicly available information about overall federal cost or savings is included in the bill text. The bill does change the Medicare Improvement Fund number in current law from 1,804,000,000 to 1,786,000,000.
No publicly available information.
No publicly available information.