Rx ACCESS Act
- Bill Number
- H.R. 6400
- Origin Chamber
- House
- Congress
- 119th Congress, Session 1
- Policy Area
- Armed Forces and National Security
- Status
- Introduced
- Latest Action
- 2025-12-03: Referred to the House Committee on Armed Services.
- Last Updated
- 2026-06-26T08:07:46Z
AI-Generated Summary
Purpose of the Legislation
The Rx ACCESS Act (H.R. 6400) aims to enhance access, fairness, and transparency in the TRICARE pharmacy benefits program, which provides prescription drug coverage to eligible military personnel, retirees, and their families. It focuses on improving how beneficiaries obtain medications, ensuring fair payments to pharmacies, and increasing oversight to maintain a reliable network of providers.
Key Provisions
- Beneficiary Choice for Medication Refills: Starting October 1, 2026, eligible TRICARE beneficiaries can choose any approved method (such as mail-order, retail pharmacies, or other options under existing rules) to receive refills of non-generic (brand-name) maintenance medications, which are drugs used for long-term conditions.
- Pharmacy Reimbursement Standards: Contracts for managing TRICARE pharmacy benefits must ensure that retail pharmacies are reimbursed at least the actual cost of acquiring the drug from a wholesaler (or a national average cost benchmark if applicable) plus a professional dispensing fee. This fee must match what the state pays pharmacies under Medicaid (a federal-state health program for low-income individuals).
- Prohibition on Fees: Pharmacy benefit managers (companies that administer drug benefits) cannot charge retail pharmacies any additional fees, including point-of-sale (at the time of purchase), retroactive, or hidden fees.
- Independent Audits: The U.S. Government Accountability Office (GAO), led by the Comptroller General, must conduct annual audits of reimbursement rates, any discounts or concessions, and the overall pharmacy network. Audits will assess access for beneficiaries, including geographic availability (with emphasis on rural and underserved areas), continuity of care, and how well the network meets personal preferences. Results will be reported to the House and Senate Armed Services Committees.
- Implementation Plan: The Secretary of Defense must submit a plan to congressional defense committees within 90 days of enactment, detailing how these changes will be put into effect. Contractors must provide data to support GAO audits.
Significant Changes to Existing Law
- Amends Section 1074g of Title 10, U.S. Code (which governs TRICARE pharmacy benefits) by expanding beneficiary options for refills beyond the current temporary provisions (which end October 1, 2026) to include permanent choice for non-generic drugs.
- Introduces new mandatory reimbursement formulas and fee prohibitions, which were not previously specified, to standardize and increase payments to pharmacies.
- Adds a dedicated subsection (i) for reimbursement and audit requirements, shifting from voluntary practices to enforceable contract conditions. It also redesignates existing subsections for organizational clarity.
Potential Impacts
- On Citizens (TRICARE Beneficiaries): Improves medication access and choice, potentially reducing barriers for military families, especially in rural areas, by ensuring a stable pharmacy network and preventing disruptions from low reimbursements that could lead to pharmacy closures.
- On Government Agencies: The Department of Defense (DoD) will face increased administrative responsibilities, including updating contracts, monitoring compliance, and coordinating with the GAO. This could raise program costs but enhance oversight and accountability.
- On International Relations: No direct impacts, as the bill focuses on domestic military health benefits.
- Broader Effects: May stabilize the pharmacy supply chain for TRICARE users, indirectly supporting military readiness by ensuring health care continuity for service members and veterans.
Main Stakeholders Affected
- TRICARE Beneficiaries: Active-duty military, retirees, and dependents who rely on the program for prescriptions.
- Retail Pharmacies: Network pharmacies that dispense drugs, benefiting from fairer reimbursements and no hidden fees, which could encourage more to participate.
- Pharmacy Benefit Managers/Contractors: Companies administering the program (e.g., current contractors like Express Scripts), required to adjust payment practices and provide audit data.
- Department of Defense: Oversees implementation and must ensure contract compliance.
- Government Accountability Office (GAO): Gains a recurring audit role to evaluate program effectiveness.
- Congressional Committees: House and Senate Armed Services Committees receive reports and audit results, influencing future oversight.
Notable Legal, Constitutional, or Political Implications
- Legal Implications: Strengthens contract enforcement under federal law by tying reimbursements to verifiable costs and benchmarks (e.g., national drug acquisition data from Medicare), potentially reducing disputes between pharmacies and managers. It promotes transparency through mandatory audits, which could lead to litigation if compliance fails but also preempts access-related lawsuits by addressing network adequacy.
- Constitutional Implications: None identified; the bill operates within Congress's authority over military benefits under Article I, Section 8 of the U.S. Constitution.
- Political Implications: Bipartisan sponsorship (from both parties) highlights support for military health improvements. It could set a precedent for similar reforms in other federal health programs like Medicare, emphasizing equity in drug pricing without altering broader drug pricing laws.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Rep. Kiggans, Jennifer A. [R-VA-2]
Cosponsors (17)
Rep. Goodlander, Maggie [D-NH-2], Rep. Luttrell, Morgan [R-TX-8], Rep. Houlahan, Chrissy [D-PA-6], Rep. Mills, Cory [R-FL-7], Rep. Davis, Donald G. [D-NC-1], Rep. Sorensen, Eric [D-IL-17], Rep. Lee, Susie [D-NV-3], Rep. Harris, Andy [R-MD-1], Rep. Turner, Michael R. [R-OH-10], Rep. Van Orden, Derrick [R-WI-3], Del. Norton, Eleanor Holmes [D-DC-At Large], Rep. Westerman, Bruce [R-AR-4], Rep. Kennedy, Timothy M. [D-NY-26], Rep. Pfluger, August [R-TX-11], Rep. Langworthy, Nicholas A. [R-NY-23], Rep. Gooden, Lance [R-TX-5], Rep. Lawler, Michael [R-NY-17]
Recent Actions
- 2025-12-03: Referred to the House Committee on Armed Services.
- 2025-12-03: Introduced in House
- 2025-12-03: Introduced in House
Bill Versions
- Rx Access, Choice, Cost Equity, and Supply Stability Act — issued 2025-12-03 — PDF (5 pages)