New TRICARE Pharmacy Copay Increases

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).

TRICARE Pharmacy copay

You prescription medication costs may increase this year.

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.

See the TRICARE pharmacy costs or the TRCIARE smart phone app for up to date information.




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Date published: January 31, 2013.

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Ryan Guina is the founder and editor of this site. He is a writer, small business owner, and entrepreneur. He served over 6 years on active duty in the USAF and is currently serving in the IL Air National Guard. He also writes about money management, small business, and career topics at Cash Money Life. You can also see his profile on Google.

Comments

  1. Bohdan Buczynski says:

    What sense does it make giving the military a COLA increase, only to have medical costs go up by the same amount? How is that helping the retirees that are living under a fixed income? How is that helping to keep medical cost down? The laws should be changed to stop this systmatic fleecing the military reirees COLA increases. How about this….give the military a 5% COLA increase and reduce the medical cost by 5%. Then maybe our quality of life can improve without decreasing our income. It use to be that military retirees did not have to worry about such things until Congress broke its promise to us (i.e, cutting medical benefits, etc). Guess they found another way to shaft us, like they always do. I wonder what the politicians would do if they were under the same benefits system as the military?

  2. R. Guy Slater says:

    Well, this sucks, but it goes back to a (court?) ruling that the promises made to us when we entered military service, having not been in writing, in effect, were not enforceable. So be it.
    I think this needs to be tweaked so that those who rely solely upon their military and/or Veteran’s Affairs Compensation/ Pension (especially Pension) either are not affected, ar are affected at a lower cost. A DVA Pension recipient of less that 100% has a restriction on ANY additional income to the FAMILY. If their pension is $100.00 per month, that is ALL they have, anything additional is deducted from their pension, dollar for dollar.
    I do not object to the provisions that are mentioned about a raise in co-payments for Doctor’s and hospitalization, but only if they apply to future retirees. I retired in ’86 with a base pay of $1449.50/month as an E-6. COLA increases do not keep me current with today’s retired pay for an E-6, and therefore make co-pay increases un-affordable, without sacrificing in some other financial area.
    I do think that the entire TRICARE situation needs to be looked at by an agency independent of the DOD and Congress, with their recommendations being overseen by someone with a military background as an enlisted person so that assumptions made are not done by a person that will not be affected by those decisions.

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