Sponsors (15)
The bill increases beneficiary convenience and strengthens payments and protections for retail pharmacies, but does so at higher federal cost and with risks of network narrowing, state-by-state payment disparities, and implementation burdens.
TRICARE beneficiaries (active-duty members, retirees, and their dependents) can choose the refill delivery method for maintenance non-generic drugs beginning Oct 1, 2026, increasing convenience and access to needed medications.
Retail pharmacies (community and hospital pharmacies) will get higher and more predictable reimbursements because TRICARE must cover actual wholesale acquisition cost or a NADAC proxy plus a state Medicaid dispensing fee, improving pharmacy revenue and financial stability.
Retail pharmacies are protected from contractor-imposed point-of-sale and retroactive fees, preserving pharmacy revenue and helping maintain local pharmacy access.
Taxpayers and the DoD health budget will likely face higher TRICARE program costs because increased reimbursements and dispensing fees raise federal spending.
TRICARE beneficiaries may experience reduced access if contractors respond to higher payments by narrowing pharmacy networks or shifting costs, which could offset the bill's access improvements.
Pharmacies in states with low Medicaid dispensing fees may still face margin pressure because tying dispensing fees to each state's Medicaid rate creates uneven payments across states.
Based on analysis of 2 sections of legislative text.
Raises minimum reimbursement for TRICARE retail pharmacy claims (WAC or NADAC proxy plus State Medicaid dispensing fee), bans certain fees, and requires annual GAO audits and an implementation plan.
Requires the Department of Defense to raise the minimum reimbursement paid to retail pharmacies that serve TRICARE beneficiaries, bans certain pharmacy fees, and orders annual GAO audits of reimbursement and network adequacy. The changes take effect October 1, 2026, and the Secretary of Defense must submit an implementation plan to congressional defense committees within 90 days of enactment.
Introduced December 3, 2025 by Jennifer Kiggans · Last progress December 3, 2025