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Changes to your TRICARE prescription drug copayments in 2022

two pharmacists

On January 1, 2022, you and your covered family members may experience an increase to prescription drug copayments.

Why the change?

Congress determined this change to prescription drug copayments in the Fiscal Year 2018 National Defense Authorization Act. Your prescription copayments vary based on where you fill your prescription and on the drug category they are in.

If you are an active duty service member (ADSM), you will continue to have $0 copays for covered drugs at military pharmacies, retail pharmacies and home delivery through Express Scripts Pharmacy.

Copayments for dependent survivors of ADSMs and medically retired service members and their dependents will remain the same.

What are the copayment changes as of January 1, 2022?

Home Delivery through Express Scripts Pharmacy (Up to a 90-day supply)

  • Generic formulary drugs will increase from $10 to $12
  • Brand-name formulary drugs will increase from $29 to $34
  • Non-formulary drugs will increase from $60 to $68

TRICARE retail network pharmacies (Up to a 30-day supply)

  • Generic formulary drugs will increase from $13 to $14
  • Brand-name formulary drugs will increase from $33 to $38
  • Non-formulary drugs will increase from $60 to $68

Non-network pharmacies (Up to a 30-day supply)

  • Generic formulary drugs and brand-name formulary drugs will cost $38 (up from $33) or 20% of the total cost, whichever is more, after you meet your annual deductible
  • Non-formulary drugs will cost $68 (up from $60) or 20% of the total cost, whichever is more, after you meet your annual deductible

Beneficiaries with a TRICARE Prime plan (including US Family Health Plan and TRICARE Young Adult - Prime option) will pay a 50% copayment after meeting the point-of-service deductibles.

How can I learn more about the cost and coverage of a medication?

The Formulary Search Tool is a digital tool that provides information about your medication coverage and cost at military pharmacies, retail network pharmacies and at home delivery through Express Scripts Pharmacy. A medication search through the Formulary Search Tool will show you:

  • Information about the drug and where it can be filled
  • Coverage results and review requirements, such as prior authorization and medical necessity forms
  • Alternative drug options
  • Copayments (if applicable)

Copayment changes for your prescription drugs will go into effect January 1, 2022.

Published on October 19, 2021

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