[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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