NGAUS Washington Report

(Jan. 29, 2013) Higher co-payments for prescription drugs covered by TRICARE will go into effect Friday, the health provider reminds participants.

The fiscal 2013 National Defense Authorization Act requires TRICARE to increase co-pays on brand name and nonformulary medications that are not filled at military clinics or hospitals. There is no increase to co-pays for generic medications.

Increases will be effective sometime in February, depending on when system changes can be made.

More details can be found at www.TRICARE.mil/pharmacycosts.

TRICARE pharmacy co-pays vary based on the class of drug and where beneficiaries choose to fill their prescriptions. The co-pay for generic medications stays at $5 when a prescription is filled at a network pharmacy.

The new co-pay for a 30-day supply of a brand name medication purchased at a retail network pharmacy will be $17, up from the current $12. Beneficiaries using TRICARE Home Delivery will pay $13 for brand name drugs, up from $9. However, the Home Delivery price is for a 90-day supply.

The greatest change in co-pays applies to non-formulary medications. The $25 co-pay for these drugs increases to $44 at retail pharmacies and $43 through Home Delivery. 

For fiscal 2014 and beyond, the new law directs that co-pays increase annually by the same percentage as retiree cost-of-living adjustments.