[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5150 Introduced in House (IH)]

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118th CONGRESS
  1st Session
                                H. R. 5150

   To direct the Secretary of Defense to submit to Congress a report 
      evaluating beneficiary access to TRICARE network pharmacies.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             August 4, 2023

  Mr. Neguse introduced the following bill; which was referred to the 
                      Committee on Armed Services

_______________________________________________________________________

                                 A BILL


 
   To direct the Secretary of Defense to submit to Congress a report 
      evaluating beneficiary access to TRICARE network pharmacies.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. REPORT ON ACCESS OF TRICARE BENEFICIARIES TO NETWORK RETAIL 
              PHARMACIES.

    (a) Report Required.--Not later than 180 days after the date of the 
enactment of this Act, the Secretary of Defense shall submit to 
Congress a report evaluating beneficiary access to TRICARE network 
pharmacies under the TPharm5 contract and changes in beneficiary access 
versus the TPharm4 contract.
    (b) Elements.--The report required under subsection (a) shall 
include the following:
            (1) An analysis of pharmacy access in rural areas under 
        such contracts, including:
                    (A) The number of TRICARE beneficiaries and number 
                of TRICARE network retail pharmacies located in rural 
                areas.
                    (B) The average drive time to the nearest TRICARE 
                network retail pharmacy for a beneficiary residing in 
                rural areas.
                    (C) The number of beneficiaries who live farther 
                than a 15-minute drive to a TRICARE retail network 
                pharmacy.
                    (D) An assessment of medication compliance rates 
                for beneficiaries residing in rural areas for the three 
                years prior to October 24, 2022, compared to the 
                period-to-date following October 24, 2022.
            (2) An analysis of TRICARE retail pharmacy network 
        capabilities under such contracts, including the number of 
        network pharmacies offering--
                    (A) long-term care services;
                    (B) prescription drug compounding services; and
                    (C) home infusion therapy services.
            (3) An analysis of affected beneficiaries and their use of 
        the TRICARE Pharmacy program under TPharm4 and TPharm5, 
        including:
                    (A) Data on affected beneficiaries' use of MTF 
                pharmacies, TRICARE mail order program, Accredo, 
                departed retail pharmacies, network retail pharmacies.
                    (B) An assessment of medication compliance rates 
                for affected beneficiaries for the three years prior to 
                October 24, 2022, compared to the period-to-date 
                following October 24, 2022.
                    (C) Data on affected beneficiaries' use of 
                pharmacies that offer long-term care services, compound 
                pharmacies, home infusion therapy.
                    (D) The number of affected beneficiaries and number 
                of total TRICARE beneficiaries by age group: under age 
                18, 18-24, 25-44, 45-64, 65-79, 80 and older.
            (4) An analysis on the effect on long-term care residents 
        under TPharm4 and TPharm5, including:
                    (A) The number of beneficiaries who filled at least 
                one prescription at a pharmacy that provides long-term 
                care services.
                    (B) The number of beneficiaries who filled 
                prescriptions at a single long-term care pharmacy only 
                with no prescriptions filled via mail order, MTF 
                pharmacy, or another retail pharmacy.
            (5) An analysis of non-network pharmacy use by TRICARE 
        beneficiaries under TPharm4 and TPharm5, disaggregated by rural 
        beneficiaries, non-rural beneficiaries, affected beneficiaries, 
        rural affected beneficiaries, and non-rural affected 
        beneficiaries:
                    (A) The number of beneficiaries who used a non-
                network pharmacy.
                    (B) The number of non-network claims submitted.
                    (C) For all non-network claims submitted--
                            (i) the average TRICARE allowed amount per 
                        prescription;
                            (ii) the average TRICARE amount paid per 
                        prescription; and
                            (iii) the average beneficiary out-of-pocket 
                        cost per prescription.
    (c) Definitions.--In this section:
            (1) The term ``affected beneficiary'' means a beneficiary 
        who filled at least one prescription in the year preceding 
        October 24, 2022, at a departed pharmacy.
            (2) The term ``beneficiary'' has the meaning given that 
        term in section 1074g(i) of title 10, United States Code.
            (3) The term ``departed retail pharmacy'' means a retail 
        pharmacy that participated in the TRICARE network in September 
        2022 but left the network with the transition to the TPharm5 
        contract.
            (4) The term ``network pharmacy'' means a retail pharmacy 
        described in section 1074g(a)(2)(E)(ii) of title 10, United 
        States Code.
            (5) The term ``rural''--
                    (A) with regards to a location, has the meaning 
                given such term in section 343(a) of the Consolidated 
                Farm and Rural Development Act (7 U.S.C. 1991(a)); and
                    (B) with regards to a beneficiary, has the meaning 
                used by the Secretary of Defense in the administration 
                of section 1074g of title 10, United States Code.
            (6) The term ``TPharm4'' means the period covered by the 
        4th Generation pharmacy contract under TRICARE prior to October 
        24, 2022, when the retail network reduction went into effect.
            (7) The term ``TPharm5'' means the period covered by the 
        5th Generation pharmacy contract under TRICARE to date.
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