Sponsors (18)
The bill expands beneficiary access and stabilizes pharmacy reimbursement to preserve retail pharmacy participation, but does so at the likely cost of higher TRICARE spending and added administrative pressures that may shift costs or program trade‑offs.
TRICARE beneficiaries with chronic conditions can obtain non‑generic maintenance medications through TRICARE mail order, retail pharmacies, or military pharmacies starting Oct 1, 2026, improving convenience and continuity of care.
Retail pharmacies (and associated hospitals/health systems) will receive reimbursements at or above their actual wholesale acquisition cost or NADAC plus a State Medicaid dispensing fee, reducing pharmacy losses and helping preserve local pharmacy access.
Contractors will be prohibited from imposing point‑of‑sale, retroactive, or hidden fees on pharmacies, protecting pharmacies from surprise charges and helping maintain retail network participation.
Taxpayers (and the TRICARE program) may face higher pharmacy spending because reimbursement floors and mandated dispensing fees increase program costs.
Contractors may respond to the prohibition on fees by seeking higher administrative payments or reducing other services or formulary generosity to offset lost fee revenue, potentially shifting costs or reducing benefits for beneficiaries.
If State Medicaid dispensing fees vary widely, TRICARE reimbursements could be higher in some states than others, creating uneven costs and potential regional disparities in pharmacy participation—hurting rural or high‑fee states.
Based on analysis of 2 sections of legislative text.
Expands TRICARE beneficiary access to non‑generic maintenance drugs, mandates minimum retail pharmacy reimbursement (WAC/NADAC + State Medicaid dispensing fee), bans contractor fees, and requires GAO audits.
Official title: To amend title 10, United States Code, to improve access to certain medications under the TRICARE program, and for other purposes.
Introduced December 3, 2025 by Jennifer Kiggans · Last progress December 3, 2025
Allows TRICARE beneficiaries starting October 1, 2026 to elect broader access to non‑generic maintenance prescriptions and imposes new minimum reimbursement rules for retail pharmacies. It bans fees charged to pharmacies by contractors, requires GAO audits of contractor reimbursement and network adequacy data, and directs the Defense Department to submit an implementation plan within 90 days of enactment.