Sponsors (17)
The bill increases TRICARE beneficiaries' access to non‑generic maintenance medications and strengthens pharmacy payment protections and oversight, but does so at the risk of higher program costs, uneven state impacts, and added administrative burdens that may be passed to taxpayers or trigger contractor adjustments.
TRICARE beneficiaries with chronic conditions can obtain non‑generic maintenance medications through multiple channels (retail, mail, or other means) beginning Oct 1, 2026, improving convenience and continuity of care.
Retail pharmacies and hospitals are protected from below‑cost reimbursements and surprise fees because reimbursements must meet or exceed actual acquisition cost (or NADAC plus a State Medicaid dispensing fee) and contractors are barred from imposing point‑of‑sale, retroactive, or hidden fees, helping preserve local pharmacy participation and financial viability.
Congressional oversight and faster DoD action are strengthened by requiring annual GAO audits, data sharing on reimbursements/network adequacy, and an implementation plan within 90 days, increasing transparency and accelerating beneficiary protections.
Taxpayers (and TRICARE program budgets) may face higher pharmacy spending because higher reimbursement floors and mandated dispensing fees increase program costs.
Contractors may seek higher administrative payments or reduce other services or formulary options to offset the loss of fee revenue from the prohibition on certain fees, potentially changing program costs or beneficiary access in other ways.
If states' Medicaid dispensing fees vary widely, reimbursements tied to those fees could raise costs in some states more than others, creating regional disparities in program costs and pharmacy participation (affecting rural or high‑fee states more).
Based on analysis of 2 sections of legislative text.
Sets pharmacy reimbursement floors for TRICARE retail pharmacies, bans contractor fees, expands beneficiary election rights for maintenance non‑generic prescriptions, and requires annual GAO audits.
Introduced December 3, 2025 by Jennifer Kiggans · Last progress December 3, 2025
Adds new rules for TRICARE pharmacy benefits that let eligible beneficiaries elect how they receive non‑generic maintenance prescriptions beginning October 1, 2026, requires minimum reimbursement levels for retail pharmacies, bans contractor fees on retail pharmacies, and directs annual GAO audits of contractor reimbursement reporting and network access. The Secretary of Defense must submit an implementation plan within 90 days of enactment, and contractors must provide GAO the information needed for the audits.