HR6400-119

What This Bill Does

The Rx ACCESS Act rewrites key TRICARE pharmacy benefit rules. Beginning October 1, 2026, eligible covered beneficiaries may elect to receive non-generic prescription maintenance medications through any authorized channel, including TRICARE retail pharmacies, rather than being steered into mail-order or military-facility channels. TRICARE pharmacy contracts must reimburse retail pharmacies at least the pharmacy actual acquisition cost from a wholesaler, or a NADAC-based proxy when available, plus a professional dispensing fee equal to the Medicaid dispensing fee paid by the State where the pharmacy is located. Contractors administering the program may not impose point-of-sale, retroactive, indirect, hidden, or other fees on TRICARE retail pharmacies. GAO must annually audit contractor-reported reimbursement rates, price concessions, and the adequacy of the retail pharmacy network and beneficiary access.

Who Benefits and How

TRICARE beneficiaries benefit from broader access to non-generic maintenance medications through retail pharmacies, including in rural or underserved areas where mail order may be less practical. Independent and chain retail pharmacies benefit from a statutory reimbursement floor and a ban on hidden or retroactive contractor fees. Rural pharmacies benefit if the network-adequacy audit pressures contractors to maintain access. GAO and Congress benefit from annual oversight data on reimbursements, concessions, and network adequacy.

Who Bears the Burden and How

TRICARE pharmacy contractors and pharmacy benefit managers bear the largest burden because they must pay at least the acquisition-cost or NADAC proxy amount plus State Medicaid dispensing fees and cannot impose hidden fees on retail pharmacies. Mail-order pharmacies may lose volume for non-generic maintenance medications. The Defense Department must enforce contract conditions. GAO must conduct annual audits. Federal taxpayers or the TRICARE program may face higher reimbursement costs.

Key Provisions

• Authorizes TRICARE beneficiaries to obtain non-generic maintenance medications through retail pharmacies beginning October 1, 2026.
• Requires retail pharmacy reimbursement at actual acquisition cost or NADAC proxy plus the State Medicaid professional dispensing fee.
• Prohibits TRICARE pharmacy contractors from imposing point-of-sale, retroactive, indirect, hidden, or other fees on retail pharmacies.
• Requires GAO to audit reimbursement rates, price concessions, network adequacy, and beneficiary access at least annually.