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In 2018, Congress passed TRICARE’s pharmacy copay increases for the next 10 years. They are implemented each even year, including 2022.
TRICARE beneficiaries initially may have been surprised to see a bill with their Express Scripts mail-order refills: Generic refills, which had no copay in 2017, now come with copays.
Beneficiaries living near a military treatment facility pharmacy network continue to receive new prescriptions and refills with no copay. Those using retail pharmacies (new 30-day prescriptions) and Express Scripts mail order (maintenance 90-day prescriptions) have copays on par with civilian counterparts who use an employer-provided medical/pharmacy plan, according to the Kaiser Family Foundation's 2021 Employer Health Benefits Survey.
Your TRICARE and TRICARE For Life pharmacy benefits work exactly alike. Your commercial pharmacy copays are the maximum you should be charged for the classification of your prescription (generic, brand, or non-formulary). Non-formulary drugs, when approved, are covered with a higher copay than drugs in the generic and brand-name formularies.
TRICARE Cost Shares, 2022-2027
- 2022-23: Retail (30-day supply) – generic, $14; brand, $38; non-formulary, $68. Mail order (90-day supply) – generic, $12; brand, $34; non-formulary, $68.
- Proposed 2024-25: Retail (30-day supply) – generic, $16; brand, $43; non-formulary, $76. Mail order (90-day supply) – generic, $13; brand, $38; non-formulary, $76.
- Proposed 2026-27: Retail (30-day supply) – generic, $16; brand, $48; non-formulary, $85. Mail order (90-day supply) – generic, $14; brand, $44; non-formulary, $85.
Many MOAA members have found that shopping around may yield a commercial pharmacy that charges less than the prescribed retail amounts above. Here are some other cost-saving ideas:
- Go generic whenever possible (with physician consent).
- Order by mail whenever possible to receive 3 times (90 versus 30) the supply for a reduced cost.
- Use a TRICARE pharmacy network or download the Express Scripts mobile app.
- If TRICARE denies coverage for your prescription needs, look into Rx discount programs such as Good Rx or AARP’s Prescription Discounts program.
- If your employer provides a Flexible Spending Account, you have coverage for prescription and over-the-counter medicines with a physician’s approval.
Have More Questions About Your Health Care Benefit?
MOAA's 2021-2022 TRICARE Guide answers some commonly asked questions.