Assessment of access, fairness, and transparency under TRICARE pharmacy benefits program

(a) Comptroller General audit Not later than one year after the date of the enactment of this Act, and not later than one year after the effective date of the first new contract or agreement entered into by the Secretary of Defense for the administration of the pharmacy benefits program after such date of enactment, the Comptroller General of the United States shall— (1) conduct an audit of— (A) data reported by the contractor responsible for the administration of the pharmacy benefits program relating to— (i) rates of reimbursement and any price concessions, including direct and indirect remuneration fees, bonuses, and clawbacks; (ii) any discrepancies between average reimbursements to various types of pharmacies disaggregated by retail, mail order, specialty pharmacies, and any pharmacy owned by or affiliated with such contractor; and (iii) the difference between what the contractor charges the TRICARE program for a pharmaceutical agent and what the contractor pays to pharmacies for the same pharmaceutical agent, disaggregated by retail, mail order, and specialty pharmacies; (B) prior authorizations required by the TRICARE program for prescription drug treatments and services; (C) the timeliness of dispensing prescription drugs from the various types of pharmacies, disaggregated by retail, mail order, and specialty pharmacies; and (D) the adequacy of the retail pharmacy network under the TRICARE program and access by eligible covered beneficiaries to such network, including with respect to continuity of care, geographic accessibility (taking into account factors in addition to travel time to and from a pharmacy, with special consideration for rural and underserved areas), and the extent to which elections by such beneficiaries reflect personal preference; and (2) submit the results of such audit to the Committees on Armed Services of the Senate and the House of Representatives. (b) Access to information (1) In general The Secretary, as a condition of any contract entered into for the administration of the pharmacy benefits program, and notwithstanding any other provision of law, or any contract, subcontract, agreement, or confidentiality provision to the contrary, shall ensure that the contractor provides the Comptroller General full access to any information the Comptroller General determines necessary to conduct the audit under subsection (a)(1) not later than 30 days after the request for such information by the Comptroller General. (2) Information To be included Information required under paragraph (1) shall include the following: (A) Claims-level data. (B) Information on reimbursement methodologies and payment rates. (C) An identification of all price concessions, including rebates, fees, discounts, and remuneration of any kind from manufacturers, pharmacies, or other entities. (D) Information on amounts charged to the Department of Defense and amounts paid to pharmacies for the same drug. (E) An identification of contracts, subcontracts, and other arrangements with manufacturers, pharmacies, or third parties relevant to the administration of the pharmacy benefits program. (3) Prohibition on withholding of information Information required to be provided under this paragraph may not be withheld, redacted, or limited on the basis of claims relating to proprietary information, trade secrets, or confidential commercial information, except that the Comptroller General shall protect such information from public disclosure in accordance with applicable law. (4) Form, detail, and frequency The Comptroller General may determine the form, level of detail, and frequency of data submissions required under paragraph (1). (5) Treatment as breach Failure to provide information required under this subsection shall constitute a material breach of contract. (c) Assessment of impact If the audit conducted under subsection (a)(1) finds that reimbursement rates paid to retail pharmacies under the pharmacy benefits program are, on average or in a systemic manner, less than the documented acquisition cost to such pharmacies for outpatient prescription drugs covered by such audit, the Comptroller General shall include with the results of such audit submitted under subsection (a)(1) an assessment of the impact of such reimbursement rates on retail pharmacy participation, beneficiary access, network adequacy, and continuity of care. (d) Access metrics In conducting oversight of the pharmacy benefit program, the Secretary of Defense shall ensure that measures of access to such program include— (1) continuity of care and beneficiary preference, including the ability of beneficiaries to remain with their pharmacy of choice; and (2) meaningful geographic access standards beyond drive-time calculations, with special consideration for rural and underserved areas. (e) Report Not later than 90 days after the date of the enactment of this Act, the Secretary of Defense shall submit to the congressional defense committees a plan for the implementation of this section. (f) Applicability to existing contracts (1) In general This section shall apply to any contract, agreement, or other arrangement in effect on or after the date of the enactment of this Act, including any contract, agreement, or arrangement entered into before such date. (2) Modification of contracts Not later than 90 days after the date of the enactment of this Act, the Secretary of Defense shall modify any existing contract or agreement as necessary to ensure compliance with the requirements of this section. (3) Limitation on extension or renewal The Secretary may not exercise any option to extend or renew an existing contract or agreement for the administration of the pharmacy benefits program unless the contractor is in full compliance with the requirements of this section. (g) Definitions In this section: (1) Eligible covered beneficiary; pharmaceutical agent; prescription drug The terms eligible covered beneficiary, pharmaceutical agent, and prescription drug have the meanings given those terms in section 1074g of title 10, United States Code. (2) Pharmacy benefits program The term pharmacy benefits program means the pharmacy benefit program of the TRICARE program under section 1074g of title 10, United States Code. (3) TRICARE program The term TRICARE program has the meaning given that term in section 1072 of title 10, United States Code.