This bill temporarily expands flexibilities under the Stark law (i.e., the Physician Self-Referral Law) for certain physicians who dispense covered outpatient drugs under the Medicare prescription drug benefit at the physician's office location (e.g., through an integrated pharmacy). The Stark law generally prohibits physicians from referring patients to receive services that are payable under Medicare or Medicaid from entities in which the physician or an immediate family member has a financial relationship.
Specifically, the bill allows, from 2026-2030, physicians to dispense such drugs from the physician's office, including through in-person pickup by a caregiver or via mail, if (1) the physician prescribed the drug, (2) the beneficiary has an ongoing relationship with the physician, (3) the beneficiary had at least one face-to-face visit with the physician in the prior year, and (4) the physician bills for the drug. These requirements also apply to physicians within the same group practice.
The Government Accountability Office must report on pharmacies or pharmacy networks that dispense significantly more covered drugs under the Medicare prescription drug benefit after the bill's enactment, the extent to which such pharmacies and networks are owned by physicians or integrated into physician practices, and the common characteristics of these types of arrangements.
