I 

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. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. REPORT ON ACCESS OF TRICARE BENE4 FICIARIES TO NETWORK RETAIL PHAR5 MACIES. 

6 (a) REPORT REQUIRED.—Not later than 180 days 

7 after the date of the enactment of this Act, the Secretary 

8 of Defense shall submit to Congress a report evaluating 

9 beneficiary access to TRICARE network pharmacies 


pbinns on DSKJLVW7X2PROD with $$_JOB
2 

•HR 5150 IH

1 under the TPharm5 contract and changes in beneficiary 

2 access versus the TPharm4 contract. 

3 (b) ELEMENTS.—The report required under sub4 section (a) shall include the following: 

5 (1) An analysis of pharmacy access in rural 

6 areas under such contracts, including: 

7 (A) The number of TRICARE bene8 ficiaries and number of TRICARE network re9 tail pharmacies located in rural areas. 

10 (B) The average drive time to the nearest 

11 TRICARE network retail pharmacy for a bene12 ficiary residing in rural areas. 

13 (C) The number of beneficiaries who live 

14 farther than a 15-minute drive to a TRICARE 

15 retail network pharmacy. 

16 (D) An assessment of medication compli17 ance rates for beneficiaries residing in rural 

18 areas for the three years prior to October 24, 

19 2022, compared to the period-to-date following 

20 October 24, 2022. 

21 (2) An analysis of TRICARE retail pharmacy 

22 network capabilities under such contracts, including 

23 the number of network pharmacies offering— 

24 (A) long-term care services; 


pbinns on DSKJLVW7X2PROD with $$_JOB
3 

•HR 5150 IH

1 (B) prescription drug compounding serv2 ices; and 

3 (C) home infusion therapy services. 

4 (3) An analysis of affected beneficiaries and 

5 their use of the TRICARE Pharmacy program 

6 under TPharm4 and TPharm5, including: 

7 (A) Data on affected beneficiaries’ use of 

8 MTF pharmacies, TRICARE mail order pro9 gram, Accredo, departed retail pharmacies, net10 work retail pharmacies. 

11 (B) An assessment of medication compli12 ance rates for affected beneficiaries for the 

13 three years prior to October 24, 2022, com14 pared to the period-to-date following October 

15 24, 2022. 

16 (C) Data on affected beneficiaries’ use of 

17 pharmacies that offer long-term care services, 

18 compound pharmacies, home infusion therapy. 

19 (D) The number of affected beneficiaries 

20 and number of total TRICARE beneficiaries by 

21 age group: under age 18, 18–24, 25–44, 45–64, 

22 65–79, 80 and older. 

23 (4) An analysis on the effect on long-term care 

24 residents under TPharm4 and TPharm5, including: 


pbinns on DSKJLVW7X2PROD with $$_JOB
4 

•HR 5150 IH

1 (A) The number of beneficiaries who filled 

2 at least one prescription at a pharmacy that 

3 provides long-term care services. 

4 (B) The number of beneficiaries who filled 

5 prescriptions at a single long-term care phar6 macy only with no prescriptions filled via mail 

7 order, MTF pharmacy, or another retail phar8 macy. 

9 (5) An analysis of non-network pharmacy use 

10 by TRICARE beneficiaries under TPharm4 and 

11 TPharm5, disaggregated by rural beneficiaries, non12 rural beneficiaries, affected beneficiaries, rural af13 fected beneficiaries, and non-rural affected bene14 ficiaries: 

15 (A) The number of beneficiaries who used 

16 a non-network pharmacy. 

17 (B) The number of non-network claims 

18 submitted. 

19 (C) For all non-network claims sub20 mitted— 

21 (i) the average TRICARE allowed 

22 amount per prescription; 

23 (ii) the average TRICARE amount 

24 paid per prescription; and 


pbinns on DSKJLVW7X2PROD with $$_JOB
5 

•HR 5150 IH

1 (iii) the average beneficiary out-of2 pocket cost per prescription. 

3 (c) DEFINITIONS.—In this section: 

4 (1) The term ‘‘affected beneficiary’’ means a 

5 beneficiary who filled at least one prescription in the 

6 year preceding October 24, 2022, at a departed 

7 pharmacy. 

8 (2) The term ‘‘beneficiary’’ has the meaning 

9 given that term in section 1074g(i) of title 10, 

10 United States Code. 

11 (3) The term ‘‘departed retail pharmacy’’ 

12 means a retail pharmacy that participated in the 

13 TRICARE network in September 2022 but left the 

14 network with the transition to the TPharm5 con15 tract. 

16 (4) The term ‘‘network pharmacy’’ means a re17 tail pharmacy described in section 

18 1074g(a)(2)(E)(ii) of title 10, United States Code. 

19 (5) The term ‘‘rural’’— 

20 (A) with regards to a location, has the 

21 meaning given such term in section 343(a) of 

22 the Consolidated Farm and Rural Development 

23 Act (7 U.S.C. 1991(a)); and 

24 (B) with regards to a beneficiary, has the 

25 meaning used by the Secretary of Defense in 


pbinns on DSKJLVW7X2PROD with $$_JOB
6 

•HR 5150 IH

1 the administration of section 1074g of title 10, 

2 United States Code. 

3 (6) The term ‘‘TPharm4’’ means the period 

4 covered by the 4th Generation pharmacy contract 

5 under TRICARE prior to October 24, 2022, when 

6 the retail network reduction went into effect. 

7 (7) The term ‘‘TPharm5’’ means the period 

8 covered by the 5th Generation pharmacy contract 

9 under TRICARE to date. 

Æ 


pbinns on DSKJLVW7X2PROD with $$_JOB