Rx ACCESS Act
- Sponsor
- Sen. Cotton, Tom [R-AR]
- Committees
- Armed Services Committee (primary)
- Last action
- Apr 13, 2026
Bottom line
The Rx ACCESS Act aims to improve TRICARE beneficiary access to medications and ensure fair compensation for retail pharmacies by regulating PBM reimbursement practices and increasing program oversight.
What it actually does
This bill amends Title 10, U.S. Code, to enhance the TRICARE pharmacy benefits program. It grants TRICARE beneficiaries the choice of how to receive non-generic maintenance medications starting October 1, 2026. Crucially, it establishes new reimbursement standards for retail pharmacies, requiring payment of at least the pharmacy's acquisition cost (or a national average proxy) plus a state Medicaid-level professional dispensing fee, while prohibiting certain fees imposed by Pharmacy Benefit Managers (PBMs). The bill also mandates annual independent audits by the Comptroller General on reimbursement rates and network adequacy.
Proponents argue
Proponents argue that the bill will significantly improve access to essential medications for TRICARE beneficiaries, particularly by strengthening the retail pharmacy network and supporting local pharmacies. They contend that ensuring fair and transparent reimbursement for pharmacies will prevent closures, promote competition, and ultimately provide service members and their families with more stable and convenient access to their prescriptions.
Opponents contend
Opponents, likely including Pharmacy Benefit Managers (PBMs), might argue that the mandated reimbursement standards and fee prohibitions could increase overall costs for the TRICARE program, potentially leading to higher expenditures for the Department of Defense or increased financial burdens on beneficiaries through other means. They may also contend that the current system is efficient in negotiating lower drug costs and that these changes could introduce unnecessary administrative complexities.
The bill is concise and its provisions are clearly articulated, making it accessible for an informed reader to understand its core impacts quickly.
Section 2(a), amending 10 U.S.C. 1074g(a)(9)
TRICARE Beneficiary Choice for Non-Generic Maintenance Medications
This provision grants eligible TRICARE beneficiaries the explicit right to choose their preferred method for receiving non-generic prescription maintenance medications, starting October 1, 2026. This change removes existing restrictions, allowing beneficiaries greater flexibility to use retail pharmacies for these prescriptions, rather than being limited to mail-order or other specific channels.
Supporters argue
Supporters argue this provision enhances patient-centered care by giving beneficiaries more control over their healthcare decisions and improving access, especially for those who prefer or need to use local retail pharmacies for their ongoing medication needs.
Critics contend
No specific opposition is typically raised against increased beneficiary choice, though Pharmacy Benefit Managers (PBMs) might argue it could reduce the cost-saving efficiencies associated with more restricted mail-order programs.
Tradeoffs
This provision balances beneficiary convenience and choice against the potential for cost efficiencies that PBMs might achieve through more centralized or restricted pharmacy networks.
Section 2(b), inserting new subsection (i) into 10 U.S.C. 1074g
Fair Reimbursement Standards for Retail Pharmacies
This provision mandates that the TRICARE pharmacy benefits program must reimburse retail pharmacies at a rate not less than the sum of the pharmacy's actual cost of acquiring a drug (or a proxy based on the national average drug acquisition cost index) and a professional dispensing fee equivalent to what the state pays under Medicaid. Additionally, it explicitly prohibits Pharmacy Benefit Managers (PBMs) from imposing various fees on retail pharmacies, including point-of-sale, retroactive, or other indirect fees.
Section 2(b), inserting new subsection (i)(3) into 10 U.S.C. 1074g
Independent Audits of TRICARE Pharmacy Program
This provision mandates that the Comptroller General of the United States conduct annual audits of the TRICARE pharmacy benefits program. These audits will specifically examine data related to PBM reimbursement rates, any price concessions, the adequacy of the retail pharmacy network (including geographic accessibility and continuity of care), and how beneficiary choices reflect personal preference. The results of these audits must be submitted to the House and Senate Armed Services Committees.
Defines the minimum reimbursement for retail pharmacies as the sum of (A) either the actual acquisition cost from a wholesaler or a proxy amount calculated at a rate not lower than the national average drug acquisition cost (NADAC) index, and (B) a professional dispensing fee equal to the professional dispensing fee paid by the State in which the pharmacy is located under title XIX of the Social Security Act (Medicaid).
Section 2(b), new 10 U.S.C. 1074g(i)(1)
Why it matters:This is standard legislative practice for referencing established benchmarks and ensuring consistency with other federal and state programs, rather than being evasive. It aims for precision by leveraging existing, recognized metrics.
Case for: Supporters argue this detailed formula ensures a fair, consistent, and transparent reimbursement floor, protecting pharmacies from being reimbursed below their costs and aligning TRICARE with best practices in other government programs like Medicaid.
Case against: Critics (PBMs) might argue that tying reimbursement to external indices and state Medicaid rates limits flexibility in negotiations and could lead to higher overall program costs if those benchmarks are not optimally managed for TRICARE's specific context, potentially reducing the PBM's ability to achieve savings.
Estimated impact: This specific calculation method directly impacts the financial health of thousands of retail pharmacies participating in TRICARE and significantly influences the overall cost structure of the TRICARE pharmacy program.
Specifies that the new beneficiary election for receiving non-generic prescription maintenance medications through any means described in paragraph (2)(E) begins on October 1, 2026.
Section 2(a), amending 10 U.S.C. 1074g(a)(9)(D)
Why it matters:This is standard legislative practice for setting an implementation timeline, allowing the Department of Defense and its contractors sufficient time to update systems, renegotiate contracts, and communicate changes to beneficiaries and pharmacies, ensuring a smooth transition. It is not intended to be evasive.
Case for: Proponents would argue that a delayed effective date is necessary to allow for proper administrative planning, system adjustments, and stakeholder communication, ensuring a seamless transition for beneficiaries and pharmacies without service disruptions.
Case against: Some beneficiaries or advocates might argue for an earlier implementation date, desiring immediate access to the expanded choices for their maintenance medications, especially if they are currently experiencing difficulties with existing options.
Estimated impact: This date determines when the expanded choice for TRICARE beneficiaries regarding non-generic maintenance medications, and the associated operational changes for pharmacies and PBMs, will officially take effect.