Sponsors (19)
The bill improves access and continuity of care for TRICARE beneficiaries and strengthens pharmacy payment protections and oversight, but does so at the risk of higher TRICARE pharmacy spending and increased administrative or contractor cost‑shifting that could raise taxpayer costs or affect program services.
TRICARE beneficiaries with chronic conditions can obtain non‑generic maintenance medications through multiple channels beginning Oct 1, 2026, increasing convenience and continuity of care.
Retail pharmacies will receive minimum reimbursements (at or above WAC or NADAC plus a State Medicaid dispensing fee) and be protected from point‑of‑sale, retroactive, and hidden fees, reducing financial losses for pharmacies and helping preserve local network participation and patient access.
Annual GAO audits and required data sharing increase transparency and congressional oversight of TRICARE pharmacy reimbursements and network adequacy, enabling policymakers and taxpayers to monitor program performance.
Higher reimbursement floors and mandated dispensing fees will likely increase TRICARE pharmacy spending, potentially raising costs for taxpayers or requiring offsets elsewhere in the budget.
Contractors may respond to fee prohibitions by seeking higher administrative payments, tightening formularies, or reducing other services, shifting costs or reducing benefits for beneficiaries.
Because State Medicaid dispensing fees vary, using them as a floor could produce higher reimbursements in some states than others, creating uneven costs and potential regional disparities in pharmacy participation (risking reduced access in high‑cost or rural areas).
Based on analysis of 2 sections of legislative text.
Expands TRICARE beneficiary choice for non‑generic maintenance prescriptions and requires minimum retail pharmacy reimbursement tied to WAC/NADAC plus a State Medicaid dispensing fee, bans contractor fees, and mandates GAO audits.
Allows TRICARE beneficiaries beginning October 1, 2026 to elect receipt of non‑generic maintenance prescriptions by a wider range of means and strengthens rules for retail pharmacy reimbursement and network practices. It mandates minimum reimbursement tied to wholesale acquisition cost or NADAC plus a State Medicaid dispensing fee, bans contractor fees on retail pharmacies, requires GAO audits of contractor reimbursement and network adequacy, and directs the Secretary of Defense to submit an implementation plan within 90 days of enactment.
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