New TRICARE Drug Co-Pays Take Effect

On Feb. 1, some TRICARE beneficiaries started paying a bit more for their prescription drugs.

Co-payments for brand-name drugs and certain generic medications increased between $2 and $4 on Monday, as a result of changes required by the fiscal 2016 National Defense Authorization Act. Co-pays for brand-name prescription drugs obtained through home delivery rose from $16 to $20 for up to a 90-day supply; the fee for up to a 30-day supply of brand-name medications at retail pharmacies also increased $4, from $20 to $24. Fees for up to a 30-day supply of generic medications at retail pharmacies rose $2 – from $8 to $10.

The fees for non-formulary drugs obtained through home delivery and network pharmacies increased $3 beginning Feb. 1.

There are no copayments for drugs obtained at military pharmacies and generic medications received through home delivery.

Click here for details and a list of co-payment changes.

TRICARE over the past year or so has encouraged beneficiaries to use home delivery whenever possible, incentivizing the option through cheaper co-payments. “Beneficiaries can save up to $208 in 2016 for each brand name prescription drug they switch from retail pharmacy to home delivery,” said a TRICARE press release on the new co-payments.

The fiscal 2015 National Defense Authorization Act included a provision requiring TRICARE beneficiaries to obtain refills for certain drug prescriptions through the mail, or at military treatment facilities, starting Oct. 1, 2015. The change, which the Defense Department estimated would save the government roughly $88 million annually and beneficiaries about $16.5 million per year, affects refills of non-generic prescription “maintenance medications,” or drugs that people take on a regular basis for chronic conditions, such as high cholesterol or blood pressure. That change does not apply to medications for sudden infections or illnesses.

Congress incrementally has increased certain drug co-payments for TRICARE beneficiaries over the last few years; the issue emerged as a sticking point during negotiations last summer between House and Senate conferees over the fiscal 2016 Defense authorization legislation. At that time, the Senate version of the bill included provisions to increase co-payments for certain prescription drugs, while the House bill did not include the hikes.

In addition to the Feb. 1 co-pay change, some TRICARE beneficiaries on Oct. 1 saw their enrollment fees increase slightly as part of the annual adjustment. TRICARE Prime beneficiaries with single coverage now pay $4.68 more for their annual enrollment fee in fiscal 2016 – an increase from the fiscal 2015 fee of $277.92 to $282.60. Those with family coverage experienced an annual increase of $9.36 beginning Oct. 1, from the fiscal 2015 fee of $555.84 to $565.20 in fiscal 2016.

The yearly increase is based on the annual cost-of-living adjustment for retired military pay. Active-duty service members and their dependents do not pay for health care under TRICARE Prime.

President Obama is expected to propose changes to TRICARE in his fiscal 2017 budget being released on Feb. 9. The administration for the last few years has supported imposing higher enrollment fees for retirees, and implementing an enrollment fee for new TRICARE-for-Life beneficiaries. 

(Image via VonaUA / Shutterstock.com)