Sponsors (6)
The bill expands access and continuity of medication care for TRICARE beneficiaries and strengthens pharmacy reimbursements and protections, but does so at increased program and administrative cost and with a risk of reducing PBM competition.
TRICARE beneficiaries — including retirees, dependents, and enrollees with chronic conditions — can obtain non‑generic maintenance medications by mail, retail, or other covered means beginning Oct 1, 2026, improving convenience and continuity of care.
Retail and community pharmacies will be reimbursed at or above their actual acquisition cost (or NADAC) plus a State Medicaid dispensing fee, supporting pharmacy financial viability and helping preserve local pharmacy access.
Prohibiting point‑of‑sale, retroactive, or hidden fee deductions protects retail pharmacies from unexpected revenue losses and helps maintain pharmacy participation in TRICARE networks, which supports beneficiary access.
Taxpayers and the Department of Defense budget — higher guaranteed reimbursements and dispensing fees are likely to increase TRICARE program costs, potentially requiring greater DoD spending or cuts/pressure on other benefits or services.
Taxpayers and beneficiaries — tighter reimbursement floors and fee prohibitions may raise PBM contract costs and deter some PBMs from bidding, reducing competition for contracts and possibly increasing net program costs or limiting contractor options.
DoD staff, federal contractors, and taxpayers — new mandated data sharing and annual GAO audits increase compliance and administrative burdens and costs, which could divert DoD resources from other program areas.
Based on analysis of 4 sections of legislative text.
Strengthens TRICARE retail pharmacy reimbursement and transparency, bans hidden fees, requires GAO audits, and allows beneficiary choice for non‑generic maintenance medication delivery starting Oct 1, 2026.
Official title: Amend title 10, United States Code, to improve access to certain medications under the TRICARE program, and for other purposes.
Introduced March 17, 2026 by Thomas Bryant Cotton · Last progress March 17, 2026
Allows TRICARE beneficiaries to elect how they receive non‑generic maintenance prescriptions beginning October 1, 2026, and changes how retail pharmacies are reimbursed under TRICARE pharmacy benefit manager (PBM) contracts. It requires minimum reimbursement equal to a pharmacy's actual acquisition cost (or CMS NADAC national average if listed) plus a State Medicaid dispensing fee, bans point‑of‑sale and other hidden fees for retail pharmacies, mandates regular audits of contractor reimbursement reporting and network adequacy, and orders a DoD implementation plan within 90 days.