What are my pharmacy copayments?

 

 

Option  Formulary Non-formulary Excluded/Not Covered

Generic

Brand Name

Generic & Brand Name

Military Pharmacy
(up to a 90-day supply)

 $0

$0 
Not Available Not available

Home Delivery
(up to a 90-day supply)

Note: If you live overseas, you must use an APO/FPO address. Home delivery isn’t available in Germany.


$13 

$38 

$76 
Not available

Network Pharmacy in the United States and U.S. Territories (Guam, Puerto Rico, the Northern Mariana Islands, and the U.S. Virgin Islands)(up to a 30-day supply)

Note: There are no network pharmacies in American Samoa.


$16 

$43 

$76 
Full cost of drug

Non-network Pharmacy in the United States and U.S. Territories (Guam, Puerto Rico, American Samoa, the Northern Mariana Islands, and the U.S. Virgin Islands)(up to a 30-day supply)

Note: You may have to pay the full amount up front and file a claim. If you're an active duty service member, you'll get full reimbursement. 

 

TRICARE Prime enrollees (including Prime Remote, US Family Health Plan, and TRICARE Young Adult - Prime option):

50% cost-shareA percentage of the total cost of a covered health care service that you pay. after you meet the point-of-service deductible ($300/person or $600/family)

All others:

$43 or 20% of total cost, whichever is more, after you meet your annual deductible

TRICARE Prime enrollees (including Prime Remote, US Family Health Plan, and TRICARE Young Adult - Prime option):

50% cost-share after you meet the point-of-service deductible ($300/person $600/family)

All others: 

$76 or 20% of total cost, whichever is more, after you meet your annual deductible

Full cost of drug

Overseas Pharmacy (not including U.S. territories) (up to a 30-day supply)

Note: If you live in the Philippines, you must get your drugs from a TRICARE-certified pharmacy.

Active duty service members and active duty family members enrolled in a TRICARE Prime Overseas option: You'll get full reimbursement after you file your claim

Active duty family members not enrolled in a TRICARE Prime Overseas option: 20% cost-share after you meet your annual deductible

All others: 25% cost-share after you meet your annual deductible
Full cost of drug 

You must get some maintenance drugsAny drug you take regularly for a chronic condition. from home delivery or a military pharmacy (if available). If not, you’ll pay the full cost for your maintenance drug. Go to the Maintenance Drugs List page to see if your drug is on the list. This doesn’t apply to you if you’re an active duty service member, have other prescription drug coverage, or live overseas. To learn more, visit the Maintenance Drugs List page

Note: Survivors of active duty service members and medically retired service members (and their families) have lower copaymentA fixed dollar amount you may pay for a covered health care service or drug. costs. Active duty service members do not have copayments for covered drugs.

 



Contact Information
Pharmacy Contractor (Express Scripts)
1-877-363-1303
http://www.express-scripts.com/tricare
DOD.customer.relations@express-scripts.com

Last Updated 10/10/2024