Active-duty military families, retirees and their families and others will pay more for their medicine, starting Jan. 1.
After holding the line on pharmacy costs for 2021, Tricare officials are increasing co-payments for 2022, with increases ranging from $1 to $8.
The increase, however, doesn’t affect active-duty service members themselves, who pay nothing for their covered medications through military pharmacies, retail network pharmacies and through the home delivery benefit. The increase also doesn’t apply to survivors of active-duty service members, or to medically retired service members and their family members, according to an announcement by Tricare officials.
The military pharmacy is still the lowest cost option for military beneficiaries; as always, there’s no cost for covered generic and brand-name drugs at these pharmacies.
The increases will apply to all categories of drugs: generic formulary drugs, brand-name formulary drugs and non-formulary drugs, and costs will depend on the type of pharmacy used.
Tricare formulary drugs are generic and brand-name prescription drugs that are covered by Tricare. You can search the list of formulary drugs here.
Tricare covers most prescription drugs approved by the Food and Drug Administration. Prescription drugs may be covered under the pharmacy benefit or the medical benefit.
The changes in co-pays taking effect Jan. 1:
Tricare Pharmacy Home Delivery (up to 90-day supply)
*Generic formulary drugs co-pays increase from $10 to $12
*Brand-name formulary drugs increase from $29 to $34
*Non-formulary drugs increase from $60 to $68
Tricare retail network pharmacies (up to 30-day supply)
*Generic formulary drugs increase from $13 to $14
*Brand-name formulary drugs increase from $33 to $38
*Non-formulary drugs increase from $60 to $68
Non-network pharmacies (up to 30-day supply)
*Generic formulary drugs and brand-name formulary drugs will increase from $33 to $38, or the co-pay will be 20 percent of the total cost of the drug, whichever is greater, after meeting the annual deductible.
*Non-formulary drugs will increase from $60 to $68, or the co-pay will be 20 percent of the total cost of the drug, whichever is greater, after meeting the annual deductible.
Non-network pharmacy costs stay the same for those who use a Tricare Prime plan, where you pay a 50-percent cost-share after meeting your point-of-service deductible for covered drugs.
Some brand-name maintenance drugs — taken for long-term conditions —can only be filled twice at retail network pharmacies. After the second refill, beneficiaries must use the home delivery option or a military pharmacy.
If you have other health insurance that includes a pharmacy benefit, you can’t use the Tricare pharmacy home delivery option unless your other health insurance doesn’t cover that prescription, or you’ve reached the dollar limit of your other plan.
Karen has covered military families, quality of life and consumer issues for Military Times for more than 30 years, and is co-author of a chapter on media coverage of military families in the book "A Battle Plan for Supporting Military Families." She previously worked for newspapers in Guam, Norfolk, Jacksonville, Fla., and Athens, Ga.
