TRICARE pharmacy copay increases, passed into law in 2017 with military health system (MHS) reforms, will go into effect in 2022.

As of Jan. 1, TRICARE copays for prescription drugs will increase as follows:

TRICARE Pharmacy Home Delivery (Up to a 90-Day Supply)

• Generic formulary drugs: from $10 to $12
• Brand-name formulary drugs: from $29 to $34
• Non-formulary drugs: from $60 to $68

 
TRICARE Retail Network Pharmacies (Up to a 30-Day Supply)

• Generic formulary drugs: from $13 to $14
• Brand-name formulary drugs: from $33 to $38
• Non-formulary drugs: from $60 to $68

Prescriptions obtained at military treatment facility (MTF) pharmacies still have zero out-of-pocket cost.

MOAA opposes disproportionate TRICARE fee increases and will continue work to stop programmed pharmacy copay hikes that are many times larger than the annual cost-of-living adjustment (COLA) and diminish the value of military retirement.

The changes came as part of the FY 2018 National Defense Authorization Act and “are part of a larger effort to help fund improvements in military readiness and modernize the TRICARE health care benefit,” said Cmdr. Teisha Robertson, USPHS, a pharmacist with the Defense Health Agency’s Pharmacy Operations Division, in a TRICARE.mil article providing background on the fee increases.  

[NOV. 2 MOAA WEBINAR: TRICARE, Medicare, and FEDVIP Open Season]

MOAA appreciates the importance of military readiness but opposes funding readiness improvements on the backs of military retirees.

The TRICARE retail and mail order pharmacy programs were extended to Medicare-eligible retirees in 2001 with the legislation that created TRICARE For Life (TFL). Until then, the only prescription drug benefit available to military retirees ages 65 and up was zero-out-of-pocket-cost prescriptions at MTF pharmacies. Since the establishment of TFL, MOAA has worked to defeat numerous proposals for disproportionate TRICARE fee increases.

As Congress shaped MHS reforms, MOAA successfully blocked dozens of proposals that would have increased beneficiary cost sharing, including a TRICARE For Life enrollment fee, multiple plans for means testing that would have led to significant cost increases for MOAA members, catastrophic cap increases up to $5,000, and a plan to index TRICARE copays to the National Health Expenditure Index, which typically grows at a much higher rate than COLA.

[MOAA IN ACTION: Major Legislative Accomplishments]

MOAA also objected to fee increases for survivors and medically retired servicemembers and their families. As a result, protections for these populations were included in the FY 2018 NDAA.

Survivors of active duty, medical retirees, and their families will not see pharmacy copay increases. There will also be no change for active duty servicemembers – covered medications will have no out-of-pocket cost whether obtained at the MTF, a retail pharmacy, or via mail order.

Please watch The MOAA Newsletter for updates on our advocacy efforts related to the TRICARE pharmacy benefit, including a call to action to share your perspectives.