Tricare Pharmacy Co-Pays Increasing

January 30, 2013 | Kate Horrell

I haven’t seen a lot of news coverage about this, and Amy Bushatz from SpouseBUZZ said, “Hey, you need to write about the increase in Tricare prescription co-pays.”

She’s absolutely right.

Effective 1 February 2013, your share of prescription costs will increase for many items.  These changes are part of the National Defense Authorization Act for Fiscal Year 2013.  Here’s the breakdown:

  • Still no co-pays for medications filled at a Military Treatment Facility (MTF).
  • Still no co-pays for active duty service members.

Home Delivery

 You may receive up to a 90-day supply for most prescriptions at the following costs:
  • $0 for generic formulary medications (no change)
  • $13 for brand-name formulary medications ($4 increase)
  • $43 for non-formulary medications, unless you establish medical necessity ($18 increase)

Network Pharmacy

You may receive up to a 30-day supply of most medications at the following costs:

  • $5 for generic formulary medications (no change)
  • $17 for brand-name formulary medications ($5 increase)
  • $44 for non-formulary medications, unless you establish medical necessity ($19 increase)

Prescriptions for more than 30 days supply will require multiple co-payments.

Non-Network Pharmacy

You’ll pay more to have prescriptions filled at non-network pharmacies (including host nation pharmacies) and costs vary based on your plan and the type of prescription.

Active duty service members still receive full reimbursement.  This does require filing a claim.

Anyone enrolled in Tricare Prime will  pay a 50% cost share, after the point of service deductible is met.

Beneficiaries using Tricare Standard, Tricare Extra, TRICARE Reserve Select, TRICARE Retired Reserve or TRICARE Young Adult pay:

  • Formulary-Generic or Brand Name: $17 or 20% of the total cost, whichever is greater, after the annual deductible is met.
  • Non-Formulary: $44 or 20% of the total cost, whichever is greater, after the annual deductible is met.

If you have your prescriptions filled outside of a Military Treatment facility, you probably want to refill any eligible prescriptions before 31 January 2013 in order to obtain the lower rates.  After the new rates come into effect, the Tricare Home Delivery program is your best bet for lowering your prescription costs if you do not have access to a MTF.    In addition to lower co-payments, the Tricare Home Delivery service offers 90 day supplies instead of 30 day supplies.

Plan ahead, check out your nearest MTF, and enroll in the Tricare Home Delivery program to keep your prescription costs low.

**This information was sourced from the Tricare website and the MOAA website.  I can’t link to the MOAA article because their website has suddenly stopped letting me see anything and is making me crazy.**

 

 

Comments

  1. Old Chief says:

    An $18 co-pay increase for my prescribed non-formulary meds is quite excessive. Who comes up with these numbers anyway?

  2. Keith says:

    Well in the non-military world, co-pays of up to $60 for branded drugs is very common…so these rates seem pretty good to me.

  3. Teresa says:

    With Tricare Prime my non-formulary co-pay is $43.00.

  4. Ken says:

    I am thankful for the system which we have as retirees, however it is much less than was promised to us during our service. We have gone through many changes and experienced a lot of out of pocket expenses since my retirement in 1976 for the "Free Medical" entitlement. Retirees are always the first to be targeted when budget reductions are inevitable….Nothing new…..we have been here before!

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