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TRICARE copayments on prescription drugs going up

FALLS CHURCH, Va. --

On Jan. 1, some copayments for prescription drugs will increase for the military retiree family. Beneficiaries who get prescriptions through the TRICARE Pharmacy Home Delivery or at a retail network pharmacy will pay anywhere from $2 to $7 more starting Jan. 1. Congress made this change in the National Defense Authorization Act for Fiscal Year 2018.

There’s still no cost to fill prescriptions at military pharmacies.

“Military pharmacies remain to be your lowest cost option,” said U.S. Air Force Lt. Col. Melissa Pammer with the Pharmacy Operations Division at the Defense Health Agency. “Your next lowest cost is if you use the TRICARE Pharmacy Home Delivery.”

Prescription copayments vary based on pharmacy type. Also, they vary based on the drug category. TRICARE groups prescription drugs into one of four categories. This grouping is based on the medical and cost effectiveness of a drug compared to other drugs of the same type.

As outlined in the TRICARE Pharmacy Program Handbook, the drug categories include:

Generic formulary drugs: These drugs are widely available and have the lowest out-of-pocket costs for these drugs.

Brand-name formulary drugs: These drugs are generally available plus they offer the second lowest copayment.

Non-formulary drugs: These drugs may have limited availability and have higher copayments. Officials say there’s generally an alternative formulary drug that is often more cost effective, and equally or more clinically effective.

Non-covered drugs:  TRICARE doesn’t cover these drugs so beneficiaries will pay 100% of the drug’s cost. These drugs are either not clinically effective, or as cost effective as other drugs offered. They may also pose a significant safety risk that may outweigh any potential clinical benefit.

People using home delivery will see copayments for up to a 90-day supply of generic formulary drugs increase from $7 to $10. For brand-name formulary drugs, copayments will increase from $24 to $29. Copayments for non-formulary drugs without a medical necessity will increase from $53 to $60.

At a retail network pharmacy, copayments for up to a 30-day supply of generic formulary drugs will increase from $11 to $13. For brand-name formulary drugs, the increase is from $28 to $33. Non-formulary drugs will increase from $53 to $60.

At a non-network pharmacy, beneficiaries must pay the full price of the drug. After meeting their annual deductible, they may submit a claim for partial reimbursement. Non-network pharmacy costs remain the same if people use TRICARE Prime. With TRICARE Prime, they will pay a 50% cost-share.

For all other health plans, non-network pharmacy costs are as follows:

Generic formulary drugs and brand-name formulary drugs will cost $33 (up from $28) or 20% of the total cost, whichever is more, after meeting the annual deductible.

Non-formulary drugs will cost $60 (up from $53) or 20% of the total cost, whichever is more, after meeting the annual deductible.

Medically retired servicemembers are not affected by these increases.

For questions and more information, visit Pharmacy on the TRICARE website.  (Courtesy of TRICARE)