New Co-pays for TRICARE Pharmacy Customers

TRICARE Management Activity (TMA) announced new TRICARE co-payments for prescription drugs effective today (February 1, 2013). The Fiscal Year 2013 National Defense Authorization Act (NDAA – P.L. 112-239) authorizes higher co-pays on brand name and non-formulary medications that are not filled at military clinics or hospitals. There is no increase to co-pays for generic medications. 

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

The greatest change in co-pays applies to non-formulary medications. The $25 co-pay for these drugs increases to $44 at retail pharmacies, and $43 through Home Delivery, and the TRICARE Uniform Formulary lists all medications TRICARE covers.

For fiscal 2014 and beyond, the new law limits annual co-pays increases to the same percentage level as retiree cost-of-living adjustments. In years when a COLA increase totals less than a dollar, it will be delayed a year and combined with the next adjustment so increases will always be $1 or more. Thanks in part to strong opposition from FRA, this plan was approved rather than much larger pharmacy co-pays proposals by the Pentagon.

Pharmacies at military hospitals and clinics continue to provide medications with no co-pays. Visit http://www.tricare.mil/Costs/PrescriptionCosts.aspxfor more details.