Summary

Creates a time‑limited exception to the physician self‑referral law so physician practices can furnish certain Medicare Part D outpatient prescription drugs to their own patients, but only from January 1, 2026 through December 31, 2030 and only if strict safeguards are met. These safeguards cover who prescribes, an ongoing patient relationship, a recent in‑person visit, where and how the drug is dispensed, and who bills. Part D plan rules (like networks, formularies, cost‑sharing, and prior authorization) stay the same. It also orders an independent study by the Comptroller General to look at pharmacies or pharmacy networks that see big increases in Part D dispensing after enactment and to analyze factors that might influence prescribing, with a report due within three years. Finally, it reduces the Medicare Improvement Fund by $18 million.

Key Points

• Allows physician practices to furnish certain Medicare Part D outpatient drugs to their patients under a narrow exception from 2026–2030.
• Exception applies only if five guardrails are met: prescriber, ongoing patient relationship, recent in‑person visit, dispensing setting/methods, and billing.
• All Medicare Part D plan rules remain in force (networks, formularies, cost‑sharing, prior authorization).
• Requires a GAO study of pharmacies or pharmacy networks with large post‑enactment increases in Part D dispensing and factors influencing prescribing.
• GAO report is due within three years of enactment.
• Reduces the Medicare Improvement Fund by $18 million (from $1.804B to $1.786B).
• No tax changes, no new appropriations, and the exception sunsets after 2030 unless extended.
• Potential benefits include convenience and adherence; risks are mitigated by strict conditions and independent oversight.

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