TRICARE Pharmacy Copays to Increase on October 1

In 2010 Congress blocked DoD from increasing TRICARE-related fees through September 30 of this year. That moratorium expires soon and based on action earlier this year, it is clear Congress no longer intends to block fees.

AFSA has confirmed that the new prescription copayments below will take effect for all non-active duty TRICARE beneficiaries on Oct. 1, 2011. Copayments for active duty beneficiaries will remain the same.

30 Day Supply
Retail Pharmacy

90 Day Supply
Home Delivery

Formulary Generic $5 $0
Formulary Brand $12 $9
Non-Formulary $25 $25

In May, the House voted to allow DoD to raise TRICARE Prime Fees and pharmacy copays for military beneficiaries. In June, the Senate Armed Services Committee agreed with their House colleagues that fees should be raised but the full chamber has yet to act on that legislation. It is unclear if TRICARE Prime fee will rise also. Language in the House and Senate versions of the FY 2012 National Defense Authorization Act would increase TRICARE Prime fees to $520 per year for family coverage and to $260 per year for individual coverage. AFSA was still trying to determine if these fees would also increase on October 1 when this alert was being prepared. We will keep you posted.

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