WRIGHT-PATTERSON AIR FORCE BASE, Ohio -- Starting Jan. 1, TRICARE pharmacy copayments will change for all beneficiaries, except active-duty service members, dependent survivors, and medically retired service members and their family members.
The increases are part of a larger Department of Defense effort to fund improvements in military readiness and modernize the TRICARE health benefit.
Congress and DOD worked together on these changes, which were passed into law as part of the National Defense Authorization Act for fiscal year 2018.
Active-duty service members will continue to pay nothing for their covered prescriptions. Copayments remain the same for survivors, medically retired service members and their family members in 2022.
All other beneficiaries will see an increase in TRICARE pharmacy copayments.
Copayment changes will vary depending on the prescription’s drug tier and whether it is filled at a military pharmacy, network retail outlet, non-network retail pharmacy or via TRICARE Home Delivery.
Military pharmacies continue to remain the lowest-cost options for TRICARE beneficiaries. There is no copayment for covered generic and brand-name drugs at these locations.
Here’s a look at the copayment changes:
- Military pharmacy
- Beneficiaries can still fill their generic and brand-name prescriptions at no cost.
- Non-formulary drugs may only be filled at a military pharmacy if a military provider prescribed the drug, or if the military treatment facility-enrolled beneficiary was referred to an outside provider.
- TRICARE pharmacy Home Delivery (up to a 90-day supply)
- Generic formulary drugs will increase from $10 to $12
- Brand-name formulary drugs go from $29 to $34
- Non-formulary drugs will increase from $60 to $68
- Network retail pharmacy (up to a 30-day supply)
- Generic formulary drugs will increase from $13 to $14
- Brand-name formulary drugs rise from $33 to $38*
- Non-formulary drugs will increase from $60 to $68*
- Non-network retail pharmacy (up to a 30-day supply)
- TRICARE Prime enrollees (including US Family Health Plan and TRICARE Young Adult-Prime option): Still a 50% copayment after meeting the point-of-service deductibles
- All other plans:
- Generic and brand-name formulary drugs will increase from $33 to $38, or be 20% of the total cost, whichever is more after meeting the annual deductible
- Non-formulary drugs will go from $60 to $68, or be 20% of total cost, whichever is more after meeting the annual deductible*
* Certain brand-name maintenance medications (long term) can only be filled twice at retail. After two refills, maintenance medications must be filled via TRICARE Home Delivery or at a military pharmacy. Acute medications (short term) are available at retail pharmacies.
More information is available at www.tricare.mil/pharmacy or in the TRICARE Pharmacy Program Overview, which can be downloaded at www.tricare.mil/publications.