FALLS CHURCH, Virginia –
Do you get prescription drugs through the TRICARE Pharmacy Program? Copayments for most beneficiaries are changing. The new costs will start Jan. 1, 2024.
“These new costs are part of the National Defense Authorization Act for Fiscal Year 2018,” said Melanie Richardson, a pharmacist in the Pharmacy Operations Division at the Defense Health Agency. “Most beneficiaries will pay $1 to $8 more per copayment. These new costs help continue to maintain high-quality delivery of your TRICARE health benefit.”
A few factors affect your pharmacy costs. Your beneficiary category is one of them.
- Active duty service members (ADSMs): You’ll pay nothing for covered drugs from military pharmacies, retail network pharmacies, and home delivery.
- Survivors of ADSMs and medically retired service members and their family members: Your copayments won’t change in 2024.
- All other beneficiaries: Your copayments will increase in 2024.
TRICARE has several categories of covered drugs. The drug category affects cost, as shown in the TRICARE Pharmacy Program Overview Fact Sheet. Generic formulary drugs are the least expensive and most widely available. This is followed by brand-name formulary drugs and non-formulary drugs.
Your costs also depend on the type of pharmacy you use. You’ll pay nothing for prescriptions from military pharmacies. See the new copayments for other pharmacy types below. New costs are in bold.
TRICARE Pharmacy Home Delivery (Up to a 90-day supply)
- Generic formulary drugs will increase from $12 to $13.
- Brand-name formulary drugs will increase from $34 to $38.
- Non-formulary drugs will increase from $68 to $76.
TRICARE retail network pharmacies (Up to a 30-day supply)
- Generic formulary drugs will increase from $14 to $16.
- Brand-name formulary drugs will increase from $38 to $43.
- Non-formulary drugs will increase from $68 to $76.
Note: If you aren’t an ADSM, you can’t refill certain maintenance drugs after two refills at retail network pharmacies unless you pay full cost for the drug. If you live in the U.S. or U.S. territories, you must refill them at a military pharmacy or through home delivery after two refills.
Non-network pharmacies (Up to a 30-day supply)
Do you have a TRICARE Prime health plan? If so, your non-network pharmacy costs will stay the same. With a TRICARE Prime plan, you’ll pay a 50% cost-share. This will happen after you meet your point-of-service deductible for covered drugs.
For other TRICARE plans, you’ll pay a copayment or cost-share after you meet your annual deductible. These costs are as follows:
- Generic and brand-name formulary drugs will cost $43 (up from $38) or 20% of the total cost, whichever is more.
- Non-formulary drugs will cost $76 (up from $68) or 20% of the total cost, whichever is more.
Have questions about your TRICARE pharmacy benefit? Go to TRICARE Pharmacy to learn more.
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