Rx ACCESS Act

Summary

Allows TRICARE beneficiaries beginning October 1, 2026 to elect how they receive non‑generic maintenance prescriptions and sets new rules for how retail pharmacies are reimbursed under PBM contracts. It requires minimum reimbursement tied to pharmacy acquisition cost or the CMS NADAC rate plus a professional dispensing fee equal to the State Medicaid dispensing fee, bans point‑of‑sale or hidden fees, mandates annual GAO audits of contractor reimbursement and network access, and directs the Defense Department to submit an implementation plan within 90 days of enactment.

• Beginning Oct 1, 2026, TRICARE beneficiaries may choose how to receive non‑generic maintenance medications through any authorized delivery channel.
• Retail pharmacies must be reimbursed at least their actual acquisition cost or the NADAC rate plus a dispensing fee equal to the State Medicaid dispensing fee.
• Contractors (PBMs) are prohibited from imposing point‑of‑sale, retroactive, or hidden fees that reduce retail pharmacy reimbursement below the required standard.
• GAO must perform annual audits of contractor reimbursement practices, price concessions, and TRICARE retail network adequacy and access.
• Contractors are required to provide GAO the data needed for audits; DoD must submit an implementation plan to congressional defense committees within 90 days of enactment.
• The law amends substantive provisions of TRICARE pharmacy law (10 U.S.C. §1074g) rather than making only technical edits.
• The bill does not specify appropriations or funding offsets; implementation and higher reimbursements could increase program costs.
• Special attention is required for rural and underserved areas to ensure geographic access and continuity of care for beneficiaries.