Seniors’ Access to Critical Medications Act of 2024 2024-09-23 Passed House Seniors’ Access to Critical Medications Act of 2024

This bill temporarily allows physicians to dispense outpatient prescription drugs and related supplies under the Medicare prescription drug benefit to patients via mail or to their caregivers without violating certain prohibitions under the Stark law (i.e., the Physician Self-Referral Law), if certain conditions are met. It also allows for coverage of certain external infusion pumps and associated home infusion drugs under Medicare.

Current law requires physicians to dispense outpatient prescription drugs and related supplies to patients in their office buildings in order to qualify for an exception (the in-office ancillary services exception) under the Stark law. The bill specifies that, from January 1, 2025 to December 31, 2029, physicians may dispense outpatient prescription drugs and related supplies to their patients via mail, and individuals or their family members or caregivers may pick up such items at the physician's office building, if the individual (1) had a face-to-face visit with the prescriber in the prior year, not including telehealth visits; (2) the prescriber furnished other items or services to the individual in the prior year; and (3) the prescriber has an ongoing professional relationship with the individual. 

In addition, the bill specifies that external infusion pumps and associated home infusion drugs may be covered under Medicare even if they don't meet certain regulatory requirements, if these items are provided in accordance with the bill's specified criteria, including that the drug is administered under the supervision of a qualified home infusion therapy supplier.

]]> 2023-09-18 Introduced in House Seniors’ Access to Critical Medications Act of 2023

This bill allows physicians to dispense outpatient prescription drugs and related supplies to patients outside of their office buildings without violating certain prohibitions under the Stark law (i.e., the Physician Self-Referral Law) for Medicare and Medicaid.

Current law requires physicians to dispense outpatient prescription drugs and related supplies to patients in their office buildings in order to qualify for an exception (the in-office ancillary services exception) under the Stark law. The bill specifies that, beginning on May 11, 2023, physicians may dispense outpatient prescription drugs and related supplies in locations other than their office buildings.

The bill also requires the Centers for Medicare & Medicaid Services to withdraw specified guidance that contradicts the bill’s changes.

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