“To amend title 10, United States Code, to improve access to certain medications under the TRICARE program, and for other purposes.”
No CRS summary available for this bill.
This section amends the TRICARE pharmacy benefits program (10 U.S.C. 1074g) as follows: (1) limits the existing beneficiary election period for receiving non-generic prescription maintenance medications through specified means to October 1, 2026 (from October 1, 2015, previously without end date), and authorizes elections through any means described in subsection (a)(2)(E) (i.e., military facilities, mail-order pharmacies, and retail network pharmacies) beginning October 1, 2026; (2) requires reimbursement under pharmacy benefit manager contracts to TRICARE retail pharmacies for pharmaceutical agents to equal at least the pharmacy's actual acquisition cost (or a proxy using the Centers for Medicare & Medicaid Services national average drug acquisition cost index) plus the applicable state Medicaid professional dispensing fee, and prohibits contractors from imposing point-of-sale fees, retroactive fees, or other indirect or hidden fees on pharmacies; (3) directs the Comptroller General to conduct not less frequently than annual audits of contractor-reported reimbursement rates and price concessions, as well as TRICARE retail pharmacy network adequacy—including continuity of care, geographic accessibility (with emphasis on rural and underserved areas), and alignment with beneficiary refill elections under subsection (a)(9)—and to report results to the House and Senate Armed Services Committees, with contractors required to provide necessary data; and (4) requires the Secretary of Defense to submit to the congressional defense committees, not later than 90 days after the date of enactment, a plan for implementing these changes.