Sponsors (5)
The bill improves beneficiary choice and protects pharmacy viability and access under TRICARE, but does so at higher program and contractor cost and with added administrative burdens that could affect competition and DoD resources.
TRICARE beneficiaries (retirees, dependents, and many veterans with chronic conditions) can obtain non‑generic maintenance medications by mail, retail, or other covered channels starting Oct 1, 2026, improving convenience and continuity of care.
Retail pharmacies (including rural and independent pharmacies, hospitals and health systems) will be reimbursed at or above actual acquisition cost (NADAC) plus a State Medicaid dispensing fee, which strengthens pharmacy financial viability and helps preserve local pharmacy access.
Prohibiting point‑of‑sale, retroactive, or hidden fee deductions protects pharmacies from unexpected reimbursements reductions, supporting pharmacy participation in TRICARE networks and stable beneficiary access.
Taxpayers and the TRICARE program face higher costs because guaranteed higher reimbursements and added dispensing fees increase DoD pharmacy spending.
PBMs and contractors may face higher contract costs and some PBMs could decline to bid under the stricter reimbursement and fee rules, reducing competition for contracts and potentially raising prices for taxpayers and beneficiaries.
Mandated data sharing and annual GAO audits increase administrative and compliance burdens for contractors and the Department of Defense, shifting staff time and resources that could otherwise support program operations.
Based on analysis of 4 sections of legislative text.
Amends TRICARE to expand delivery options for non‑generic maintenance meds, require retail reimbursement at acquisition cost/NADAC plus State Medicaid dispensing fee, ban hidden fees, and mandate GAO audits.
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-eligible beneficiaries, beginning October 1, 2026, to elect expanded delivery options for non‑generic maintenance prescriptions and imposes new pharmacy reimbursement and transparency rules on pharmacy benefit manager (PBM) contracts. It requires retail pharmacy reimbursement to cover actual acquisition cost (or NADAC) plus a professional dispensing fee equal to the State Medicaid dispensing fee, bans point-of-sale and retroactive fees, mandates annual Comptroller General audits of contractor pricing and network adequacy, and directs the Secretary of Defense to submit an implementation plan to congressional defense committees within 90 days of enactment. The bill changes substantive law governing 10 U.S.C. § 1074g (TRICARE pharmacy benefits), increases oversight of contractor reporting and payments, and aims to protect retail pharmacies, preserve beneficiary access (including rural/underserved areas), and improve transparency in PBM practices serving the military health system.