Veterans

January 25, 2013

New co-pays for TRICARE pharmacy customers

New co-payments for prescription drugs covered by TRICARE will go into effect soon.

The Fiscal Year 2013 National Defense Authorization Act requires TRICARE to increase 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. Increases will be effective sometime in February, depending on when system changes can be made, and the publication of a required Federal Notice.

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 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 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 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. The TRICARE Uniform Formulary is a list of all the medications TRICARE covers.

For fiscal 2014 and beyond, the new law directs that co-pays 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 co-pays. Visit http://www.tricare.mil/Costs/PrescriptionCosts.aspx for more details.

 




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