“A bill 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 modifies the TRICARE pharmacy benefits program (i.e., pharmacy benefits for eligible covered beneficiaries, including members of the uniformed services, retirees, and families) as follows: (1) limits the existing beneficiary election period for prescription refill means under subsection (a)(9)(A) to end on October 1, 2026 (from previously indefinite beginning October 1, 2015), and authorizes eligible covered beneficiaries beginning October 1, 2026, to elect non-generic prescription maintenance medications through any means described in subsection (a)(2)(E) (e.g., military facilities, mail-order, retail pharmacies); (2) establishes reimbursement standards requiring pharmacy benefit managers, as a contract condition, to pay retail pharmacies at least the actual acquisition cost or the national average acquisition cost published by the Centers for Medicare & Medicaid Services (whichever is lower), plus the state's Medicaid professional dispensing fee, and prohibits contractors from imposing any fees (e.g., point-of-sale, retroactive) on such pharmacies; (3) requires the Comptroller General to conduct annual audits of reimbursement rates, price concessions, and retail pharmacy network adequacy (including continuity of care, geographic access with emphasis on rural areas, and alignment with beneficiary preferences under subsection (a)(9)), submitting results to the Senate and House Armed Services Committees, with the Secretary ensuring contractor data access; and (4) directs the Secretary of Defense to submit to the congressional defense committees, not later than 90 days after enactment, a plan for implementing these changes.