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Fort Carson Mountaineer

TRICARE: Pharmacy copayments to increase

By TRICARE Communications

FALLS CHURCH, Va. — Beneficiaries who receive prescription drugs through TRICARE Pharmacy Home Delivery or at a TRICARE retail network pharmacy will pay anywhere from $1 to $8 more in copayments starting Jan. 1, 2022.

“Congress and the Department of Defense worked together on these cost changes as part of the National Defense Authorization Act for Fiscal Year 2018,” said U.S. Public Health Service Commander Teisha Robertson, a pharmacist with the Defense Health Agency’s Pharmacy Operations Division. “The changes are part of a larger effort to help fund improvements in military readiness and modernize the TRICARE health care benefit.”

These costs changes won’t affect all beneficiaries. Active-duty service members (ADSM) will not pay for drugs at military pharmacies, retail network pharmacies and through home delivery. Copayments for survivors of ADSMs will remain the same. Medically retired service members and their family members also won’t see a change in their copayments next year.

As described in the TRICARE Pharmacy Program Overview, TRICARE groups prescription drugs are based on the medical and cost effectiveness of a drug compared to other drugs of the same type. The cheapest, most widely available category is generic formulary drugs. This is followed by brand-name formulary drugs and non-formulary drugs. There will be cost increases in all three of these categories. The new cost will depend on the type of pharmacy.

Here are the new copayment changes.

TRICARE Pharmacy Home Delivery (up to a 90-day supply)

  • Generic formulary drugs will increase from $10 to $12.
  • Brand-name formulary drugs will increase from $29 to $34.
  • Non-formulary drugs will increase from $60 to $68.

TRICARE retail network pharmacies (up to a 30-day supply)

  • Generic formulary drugs will increase from $13 to $14.
  • Brand-name formulary drugs will increase from $33 to $38.
  • Non-formulary drugs will increase from $60 to $68.

It’s important to note that some brand-name maintenance drugs can only be filled twice at retail network pharmacies. These are drugs taken for long-term conditions. After the second refill, beneficiaries must use home delivery or a military pharmacy. This doesn’t apply to filling short-term use drugs at retail network pharmacies.

Non-network pharmacies (up to a 30-day supply)

Non-network pharmacy costs remain the same for those with a TRICARE Prime plan. With a TRICARE Prime plan, there is a 50% cost-share after meeting the point-of-service deductible for covered drugs. For all other health plans, non-network pharmacy costs are as follows:

  • Generic formulary drugs and brand-name formulary drugs will cost $38 (up from $33) or 20% of the total cost, whichever is more, after meeting the annual deductible.
  • Non-formulary drugs will cost $68 (up from $60) or 20% of the total cost, whichever is more, after meeting the annual deductible.

Keep in mind, using a military pharmacy remains the lowest cost option.

There’s still no cost for covered generic and brand-name drugs at military pharmacies.

For questions about TRICARE pharmacy benefits, visit https://www.tricare.mil/pharmacy.

TRICARE: Pharmacy copayments to increase
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