LVMAC Tidbit — New TRICARE Pharmacy Copays for 2013

As a result of the enacted Fiscal Year National Defense Authorization Act of 2013, beginning this February new  copayments for prescription drugs purchased through TRICARE off-base are about to go into effect. Off-base TRICARE Pharmacy copays will continue to vary based upon class of drug and where beneficiaries choose to fill their prescriptions.

For generic medications there is no change from last year:
1)  Fulfillment at a retail network pharmacy:  $5;
2)  Fulfillment through TRICARE Home Delivery: no copayment.

Copayment increases are occurring for brand name medications:
1)  Fulfillment at a retail network pharmacy: $17 for a 30-day supply (formerly $12);
2)  Fulfillment through TRICARE Home Delivery: $13 for a 90-day supply (formerly $9).

However, the greatest change in copays applies to non-formulary medications, unless  medical necessity is established:
1)  Fulfillment at a retail network pharmacy: $44 (formerly $25);
2)  Fulfillment through TRICARE Home Delivery:  $43 (formerly $25).

Pharmacies at military hospitals and clinics will continue to provide medications with no copays.

According to the TRICARE website, for Fiscal 2014 and beyond, the new law directs that copays increase annually by the same percentage as retiree cost-of-living adjustments. In years when a COLA increase would total less than a dollar, it will be delayed a year and combined with the next adjustment so increases will always be $1 or more.

For a list of all the medications TRICARE covers, consult the TRICARE Uniform Formulary Search Engine.

Visit www.TRICARE.mil/costs for more details.

Sources: 
<http://tricare.mil/CoveredServices/BenefitUpdates/Archives/PharmacyCopayChanges.aspx> (Accessed 16 January)
<http://www.tricare.mil/Costs/PrescriptionCosts.aspx> (Accessed 16 January)

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 As of 11 January 2013
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