To amend title 10, United States Code, to improve access to certain medications under the TRICARE program, and for other purposes.
Sponsors
Legislative Progress
IntroducedMrs. Kiggans of Virginia (for herself, Ms. Goodlander, Mr. Luttrell, …
Summary
What This Bill Does
The Rx ACCESS Act reforms the TRICARE military health pharmacy program by giving military families more choices for filling their prescriptions. Starting October 2026, TRICARE beneficiaries will be able to pick up non-generic maintenance medications at their local retail pharmacy instead of being required to use mail-order pharmacies. The bill also protects pharmacies from being shortchanged by the companies that manage TRICARE's pharmacy benefits.
Who Benefits and How
Military service members and their families gain flexibility to use neighborhood pharmacies for regular medications like blood pressure or cholesterol drugs. Independent pharmacies and retail chains like CVS and Walgreens benefit from guaranteed reimbursement at fair rates (acquisition cost plus dispensing fees) and protection from hidden fees that pharmacy benefit managers often charge. Rural pharmacies, in particular, benefit from stronger network adequacy requirements and fair reimbursement standards.
Who Bears the Burden and How
Pharmacy benefit managers (PBMs) like Express Scripts, which currently administers the TRICARE contract, face new restrictions on their business practices. They can no longer charge pharmacies point-of-sale fees, retroactive fees, or other hidden charges, and must meet minimum reimbursement requirements. Mail-order pharmacies may lose business as beneficiaries shift to retail options. The Government Accountability Office takes on annual audit responsibilities, and the Department of Defense may face higher program costs.
Key Provisions
- Allows TRICARE beneficiaries to fill non-generic maintenance prescriptions at any participating retail pharmacy starting October 2026
- Requires PBMs to reimburse pharmacies at least the national average drug acquisition cost (or actual wholesale cost) plus the state Medicaid dispensing fee
- Prohibits PBMs from charging hidden fees to retail pharmacies
- Mandates annual GAO audits of PBM reimbursement practices and pharmacy network adequacy
- Requires special consideration for rural and underserved areas in network adequacy assessments
Evidence Chain:
This summary is derived from the structured analysis below. See "Detailed Analysis" for per-title beneficiaries/burden bearers with clause-level evidence links.
Primary Purpose
Improves access to prescription medications under the TRICARE pharmacy benefits program by allowing beneficiaries to obtain non-generic maintenance medications from retail pharmacies, setting minimum reimbursement standards for pharmacies, and prohibiting hidden fees by pharmacy benefit managers.
Policy Domains
Legislative Strategy
"Protect retail pharmacies from below-cost reimbursements and hidden PBM fees while expanding medication access options for military beneficiaries"
Likely Beneficiaries
- TRICARE beneficiaries (military members and dependents) who prefer retail pharmacies
- Independent and retail pharmacies serving TRICARE patients
- Rural pharmacies that may currently be undercompensated
Likely Burden Bearers
- Pharmacy benefit managers administering TRICARE contracts
- Express Scripts (current TRICARE PBM contractor)
- Department of Defense (potential increased contract costs)
Bill Structure & Actor Mappings
Who is "The Secretary" in each section?
- "the_secretary"
- → Secretary of Defense
- "the_contractor"
- → TRICARE pharmacy benefits program administrator (pharmacy benefit manager)
- "the_administrator"
- → Administrator for the Centers for Medicare and Medicaid Services
- "the_comptroller_general"
- → Comptroller General of the United States (GAO)
Key Definitions
Terms defined in this bill
Index published by CMS Administrator showing average pharmacy acquisition costs for pharmaceutical agents
A prescription medication dispensed under the TRICARE pharmacy benefits program
A retail pharmacy described in 10 U.S.C. 1074g(a)(2)(E)(ii) that participates in the TRICARE pharmacy network
Fee paid by states under Medicaid (Title XIX of Social Security Act) for dispensing prescription drugs
Military service members and dependents eligible for TRICARE pharmacy benefits under 10 U.S.C. 1074g
We use a combination of our own taxonomy and classification in addition to large language models to assess meaning and potential beneficiaries. High confidence means strong textual evidence. Always verify with the original bill text.
Learn more about our methodology