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New Copays for Some TRICARE Pharmacy Customers

1/28/2013

FALLS CHURCH, Va. – New copayments for prescription drugs covered by TRICARE will go into effect February 1, 2013. The Fiscal Year 2013 National Defense Authorization Act requires TRICARE to increase copays on brand name and non-formulary medications that are not filled at military clinics or hospitals.  There is no increase to copays for generic medications.

TRICARE Pharmacy copays vary based on the class of drug and where beneficiaries choose to fill their prescriptions. The copay for generic medications stays at $5 when a prescription is filled at a network pharmacy.  There is no co-pay when generic prescriptions are filled through TRICARE Home Delivery.  The new copay for a 30-day supply of a brand name medication purchased at a retail network pharmacy will be $17, up from the current $12. Beneficiaries using TRICARE Home Delivery will pay $13 for brand name drugs, up from $9. However, the Home Delivery price is for a 90-day supply. 

The greatest change in copays applies to non-formulary medications. The $25 copay for these drugs increases to $44 at retail pharmacies and $43 through Home Delivery. The TRICARE Uniform Formulary is a list of all the medications TRICARE covers.

For fiscal 2014 and beyond, the new law directs that copays increase annually by the same percentage as retiree cost-of-living adjustments. In years when a COLA increase would total less than a dollar, it will be delayed a year and combined with the next adjustment so increases will always be $1 or more.

Pharmacies at military hospitals and clinics will continue to provide medications with no copays.  Visit www.TRICARE.mil/pharmacycosts for more details.

Last Updated 7/9/2014