Rx ACCESS Act Guarantees TRICARE Users Can Pick Local Pharmacies for Maintenance Meds, Cracks Down on Hidden Fees

The Rx ACCESS Act is stepping in to shore up the TRICARE pharmacy benefit program, focusing on better access and fairer payment for local pharmacies serving military families. The core idea is simple: make sure beneficiaries can use their neighborhood pharmacy without getting squeezed into mail-order programs, and make sure those pharmacies can afford to stay open.

The Right to Choose Your Pharmacy

Right now, if you’re a TRICARE beneficiary needing long-term maintenance medications (like prescriptions for blood pressure or diabetes), you might be pushed toward mail-order or military treatment facility pharmacies. This bill changes that. It extends the current ability to choose how you get non-generic maintenance medications until October 1, 2026. After that date, the choice becomes permanent: an eligible beneficiary can elect to receive these non-generic maintenance drugs through any TRICARE retail pharmacy. For military families who move frequently or those living far from a military base, this is a big win for convenience and continuity of care. You get to stick with the pharmacist who knows your history, rather than waiting for a package in the mail.

Putting Cash Back in the Local Pharmacy

This section also tackles a major pain point for retail pharmacies: reimbursement. Pharmacies often complain that the administrators (known as Pharmacy Benefit Managers or PBMs) pay them less than the drug actually costs, sometimes forcing them to fill prescriptions at a loss. The Rx ACCESS Act sets a hard floor for reimbursement standards. Under this bill, TRICARE must pay the pharmacy at least the sum of two things:

1. The actual cost to acquire the drug (or a proxy based on the National Average Drug Acquisition Cost index).
2. A professional dispensing fee equal to the fee paid by the state’s Medicaid program.

This means if a local pharmacy in Texas fills a prescription, they must get paid the cost of the drug plus whatever dispensing fee Texas Medicaid pays. This provision, found in Section 2, is designed to stabilize the retail pharmacy network, especially the independent shops that often serve rural or underserved areas. It guarantees they aren't losing money just to serve TRICARE members.

Banning Hidden Fees and Mandating Audits

Another major protection is the flat-out prohibition on the TRICARE program administrator imposing any fees on a TRICARE retail pharmacy. This includes point-of-sale fees, retroactive fees, or any other “indirect or hidden fees.” If you’ve ever had a bill that seems to grow after the fact, you know how frustrating this is—and for a small business like a pharmacy, these fees can be devastating. This bill cuts off that practice.

To ensure the system actually works as intended, the bill mandates annual audits by the Comptroller General of the United States. These audits will look at the contractor’s reimbursement rates, any price concessions, and, crucially, the adequacy of the TRICARE retail pharmacy network. They want to know if beneficiaries are truly able to access the care they need, geographically and personally. This is policy with built-in accountability, ensuring that the new rules aren't just ignored after the ink dries. The Secretary of Defense is required to submit an implementation plan within 90 days of the bill’s enactment, putting the DoD on the clock to make these changes happen quickly.