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TRICARE Pharmacy Copays are Changing

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A Guide to 2020 Pharmacy Copayments

On Jan. 1, some copayments for prescription drugs will increase. If beneficiaries get their prescriptions through the TRICARE Pharmacy Home Delivery or at a retail network pharmacy, they’ll pay anywhere from $2 to $7 more starting Jan. 1. Congress made this change in the National Defense Authorization Act for Fiscal Year 2018.

There’s still no cost to fill prescriptions at military pharmacies. And these cost changes don’t apply to active duty service members (ADSMs). ADSMs still pay nothing for covered drugs at military and network pharmacies. Copayments for survivors of ADSMs are the same as the 2017 rates. Copayments remain the same for medically retired service members and their family members, too.

2020 Pharmacy Copayment Resources

These resources explain the pharmacy copayment increases. Utilize the tools in the resources sidebar as visual aids to outline the copayment changes and pharmacy options. Download and print the infographic and share with beneficiaries. Use the chart as a quick reference for current versus 2020 costs, and post the Did You Know image on social media. 

Copayment Changes: The Details

Prescription copayments vary based on pharmacy type. Also, they vary based on the drug category. TRICARE groups prescription drugs into one of four categories. This grouping is based on the medical and cost effectiveness of a drug compared to other drugs of the same type.

As outlined in the TRICARE Pharmacy Program Handbook, the drug categories include:

  • Generic formulary drugs: These drugs are widely available. Beneficiaries have the lowest out-of-pocket costs for these drugs.
  • Brand-name formulary drugs: These drugs are generally available. Plus, they offer the second lowest copayment.
  • Non-formulary drugs: These drugs may have limited availability. Beneficiaries have higher copayments for these drugs. Also, there’s generally an alternative formulary drug available. It’s often more cost effective, and equally or more clinically effective.
  • Non-covered drugs: TRICARE doesn’t cover these drugs. If beneficiaries choose to purchase a non-covered drug, they’ll pay 100% of the drug’s cost. These drugs are either not clinically effective, or as cost effective as other drugs offered. They may also pose a significant safety risk that may outweigh any potential clinical benefit.

To learn more, download the TRICARE Pharmacy Program Handbook from the TRICARE publications page

Pharmacy Copayment Increases

TRICARE Pharmacy Home Delivery

Using home delivery, copayments for up to a 90-day supply of generic formulary drugs will increase from $7 to $10. For brand-name formulary drugs, copayments will increase from $24 to $29. Copayments for non-formulary drugs without medical necessity will increase from $53 to $60.

TRICARE retail network pharmacies

At a retail network pharmacy, copayments for up to a 30-day supply of generic formulary drugs will increase from $11 to $13. For brand-name formulary drugs, the increase is from $28 to $33. Non-formulary drugs will increase from $53 to $60.

Non-network pharmacies

At a non-network pharmacy, beneficiaries must pay the full price of the drug. After meeting the annual deductible, beneficiaries may submit a claim for partial reimbursement. Non-network pharmacy costs remain the same as previous years for TRICARE Prime beneficiaries. With TRICARE Prime, beneficiaries pay a 50% cost-share after meeting their 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 $33 (up from $28) or 20% of the total cost, whichever is more, after meeting the annual deductible.
  • Non-formulary drugs will cost $60 (up from $53) or 20% of the total cost, whichever is more, after meeting the annual deductible.

For the latest TRICARE pharmacy costs, visit TRICARE Costs. To learn more about the pharmacy benefit, visit Pharmacy on the TRICARE website.

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2020 Copay Changes DYK

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TRICARE Pharmacy Options

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2020 Copay Infographic

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Infographic outlining current and 2020 TRICARE pharmacy copayments.

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2020 Copay Chart

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Chart outlining current and future 2020 pharmacy copayment costs for each point of service

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