Big news for TRICARE beneficiaries: the cost of TRICARE pharmacy copays is increasing for many individuals on Feb 1, 2013. These changes were authorized as part of the Fiscal Year 2013 Defense Authorization Act and will increase the cost of prescription copays on brand name and non-formulary medications that aren’t filled at military hospitals or clinics. The good news is there is no increase in copays for generic medications (in most cases, generic medications are still free or $5 for most TRICARE members).
In addition to these copay increases, the law also allows TRICARE to increase co-payments each year by the same percentage of the retiree Cost of Living Adjustment (COLA). There is a condition to the COLA increase: the increase must be at least $1; if not, it will carry over to the next year and then be implemented. Let’s take a look at the changes and how they will affect your bottom line.
How TRICARE Pharmacy Copay Changes Will Affect You
Who will be affected: The first thing to note is that this only applies to medications that are filled outside of pharmacies located at military hospitals and clinics. In other words, if you don’t live near a military installation, or normally get your prescriptions filled at an off-base location, your copays may be increased. This usually affects more retirees than active duty individuals. However, this may affect some active duty members who are stationed away from military installations, including recruiters and those who are assigned to remote locations and embassies.
Prescription copay increases: Here is a sampling of the TRICARE prescription medication copay increases (Current copay first, then upcoming copay):
Home Delivery by mail (for up to 90 day supplies):
- Generic medications: free by mail (No increase)
- 90-day prescription brand-name formulary medications: $9 to $13 ($4 increase)
- 90-day prescription non-formulary medications: $25 to $43 ($18 increase)
- Generics: free by mail
Retail copay at Network Pharmacies (for up to 30 day supplies):
- Generic: $5 (No increase)
- Formulary prescription brand-name medications: from $12 to $17 ($5 increase)
- Non-formulary prescription medications: $25 to $44 ($19 increase)
Note: If you want to have a 90-day prescription filled, you will pay the copayment for each 30-day supply.
Retail copay at Non-Network Pharmacies (for up to 30 day supplies): Prescriptions filled at non-network pharmacies and host nation pharmacies generally cost more, and will vary, depending on the type of prescription you have filled. According to TRCIARE:
- Active duty service members will receive a full reimbursement after they file a claim.
- All others enrolled in a Prime option pay 50% cost share after the point of service deductible is met.
- Beneficiaries using Standard/Extra, TRICARE Reserve Select, TRICARE Retired Reserve or TRICARE Young Adult pay:
- Formulary-Generic or Brand Name: $12 ($17 beginning February 1, 2013) or 20% of the total cost, whichever is greater, after the annual deductible is met
- Non-Formulary: $25 ($44 beginning February 1, 2013) or 20% of the total cost, whichever is greater, after the annual deductible is met
TRICARE for Life and Medicare Eligible Retirees
This price increase will affect some more than others, particularly retirees and those on fixed incomes. Because of this, there were some compromises in the FY13 Defense Bill that will provide for a pilot program that allows Medicare-eligible retirees and their family members participating in TRICARE for Life to receive common medications via mail for a minimum of a year, or to get them from a military pharmacy in lieu of obtaining them from a commercial pharmacy. The details for this program have not yet been released. Please check back for more information.
The good news is that TRICARE members can always receive their prescription medications free of charge when they obtain them from a military clinic or hospital. It’s important to note that not all medications are available at all military pharmacies. Non-formulary medications and certain other prescriptions are not usually filled at military pharmacies. Be sure to check for availability or ask your doctor if there is another equivalent option for your prescription. Your doctor may be able to give you a prescription that will work equally well, but will cost much less.