Rx Access, Choice, Cost Equity, and Supply Stability Act; Rx ACCESS Act
Summary
H.R. 6400, also known as the Rx ACCESS Act, aims to amend Title 10 of the United States Code to improve access to medications under the TRICARE program. The bill focuses on enhancing fairness and transparency within the TRICARE pharmacy benefits program. It addresses beneficiary election of prescription refill means and pharmacy benefit manager reimbursement standards.
Expected Effects
The bill will allow TRICARE beneficiaries to have more choices in how they receive their non-generic maintenance medications starting October 1, 2026. It also mandates specific reimbursement standards for pharmacies, ensuring they receive at least the actual cost of the drug or the national average acquisition cost, plus a professional dispensing fee. Furthermore, it requires annual audits by the Comptroller General to assess reimbursement rates and the adequacy of the TRICARE retail pharmacy network.
Potential Benefits
- Increased choice for beneficiaries in receiving maintenance medications.
- Ensures fair reimbursement to TRICARE retail pharmacies.
- Enhances transparency in pharmacy benefit manager practices.
- Provides oversight through annual audits by the Comptroller General.
- May improve access to pharmacies in rural and underserved areas.
Potential Disadvantages
- Potential for increased costs to the TRICARE program, which could impact taxpayers.
- Implementation challenges in ensuring compliance with new reimbursement standards.
- The 90-day timeframe for the Secretary of Defense to submit an implementation plan may be too short.
- Possible delays in access to medications if pharmacies are slow to adapt to the new regulations.
- The focus is primarily on non-generic medications, potentially overlooking cost-saving opportunities with generics.
Constitutional Alignment
The bill appears to align with the Constitution's general welfare clause, as it aims to improve healthcare access for military families. Congress has the power to legislate for the armed forces under Article I, Section 8, which includes providing for their healthcare needs. The required audits also align with Congress's oversight responsibilities.
Impact Assessment: Things You Care About ⓘ
This action has been evaluated across 19 key areas that matter to you. Scores range from 1 (highly disadvantageous) to 5 (highly beneficial).