- Tricare Prime Copay Increase
- Tricare Prime Copay For Ct Scan
- Tricare Prime Copay 2019
- Tricare Prime Copay 2021
$3,000/family (TRICARE Prime) $3,500/family (TRICARE Select) $3,703/family TRS members (Follow Group B) $1,058/family TRR members (Follow Group B) $3,703/family 3 PHARMACY COSTS (JAN. 31, 2021) ADSMs have no prescription drug costs when using a military pharmacy, TRICARE Pharmacy Home Delivery, or a TRICARE retail. Retirees covered under TRICARE Prime will also see minor copay increases. These will apply to emergency room visits, outpatient surgery and ground ambulance. Copays for these items will increase by $1. Also, copays for inpatient admissions will increase by $4 per admission.
Covered Services
Note: Visit our Copayment and Cost-Share Information page to view 2020 costs. Ambulatory surgery costs apply to same day surgery in an outpatient hospital setting or ambulatory surgery center. TRICARE Select, TRICARE Young Adult Select, TRICARE Reserve Select, and TRICARE Retired Reserve annual deductibles apply.; TRICARE Young Adult costs are based on the sponsor's status. Copayments and cost-shares are subject to change at the beginning of each calendar year. Copayments are per occurrence or per visit. Cost-shares are a percentage of the contracted rate for network providers and the maximum TRICARE allowable for non-network providers on certain types of services.
Learn more about what we cover -including health, dental, and pharmacy.
On Jan. 1, some copayments for your prescription drugs will increase. If you get your prescriptions through the TRICARE Pharmacy Home Delivery or at a retail network pharmacy, you’ll pay anywhere from $2 to $7 more starting Jan. 1. Congress made this change in the National Defense Authorization Act for Fiscal YearOctober 1 - September 30 2018.
There’s still no cost to fill your prescriptions at military pharmacies. And these cost changes don’t apply to active duty service members (ADSMs). If you’re an ADSM, you still pay nothing for your covered drugs at military and network 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.”
TRICARE Prescription Drug Categories
Your 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. You have the lowest out-of-pocket costs for these drugs.
- Brand-name formulary drugs: These drugs are generally available to you. Plus, they offer you the second lowest copaymentA fixed dollar amount you may pay for a covered health care service or drug..
- Non-formulary drugsA drug in a therapeutic class that isn’t as clinically or cost-effective as other drugs in the same class. You pay a higher cost share for these drugs.: These drugs may have limited availability. You have higher copayments for these drugs. Also, there’s generally an alternative formulary drug that you can get. It’s often more cost effective, and equally or more clinically effective.
- Non-covered drugs: TRICARE doesn’t cover these drugs. If you choose to purchase a non-covered drug, you’ll 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.
To learn more, you can download the TRICARE Pharmacy Program Handbook from the Publications page.
Pharmacy Copayment Increases
TRICARE Pharmacy Home Delivery
Tricare Prime Copay Increase
If you use home delivery, your copayments for up to a 90-day supply of generic formulary drugs will increase from $7 to $10. For brand-name formulary drugs, your copayments will increase from $24 to $29. Your copayments for non-formulary drugs when you don’t have a medical necessity will increase from $53 to $60.
TRICARE retail network pharmacies
At a retail network pharmacy, your 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.
Non-network pharmacies
At a non-network pharmacy, you must pay the full price of the drug. After meeting your annual deductible, you may submit a claim for partial reimbursement. Non-network pharmacy costs remain the same if you use TRICARE Prime. With TRICARE Prime, you’ll pay a 50% cost-shareA percentage of the total cost of a covered health care service that you pay. after meeting your point-of-service deductible for covered drugs.
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 you meet your annual deductible.
- Non-formulary drugs will cost $60 (up from $53) or 20% of the total cost, whichever is more, after you meet your annual deductible.
Copayments for survivors of ADSMs are the same as the 2017 rates. The copayments remain the same for medically retired service members and their family members, too.
For the latest TRICARE pharmacy costs, you should visit TRICARE Costs. To learn more about your pharmacy benefit, visit Pharmacy on the TRICARE website.
Last Updated 2/17/2021
Coronavirus (COVID-19) Update:
Providers are expected to refund cost-sharing amounts to beneficiaries as appropriate. |
- TRICARE Select, TRICARE Young Adult Select, TRICARE Reserve Select, and TRICARE Retired Reserve annual deductibles apply.
- TRICARE Young Adult costs are based on the sponsor's status.
- Transitional Assistance Management Program (TAMP) beneficiaries (service members and their family members) follow the active duty family member copayment/cost-share information, based on the TRICARE plan type.
A beneficiary's cost is determined by the sponsor's initial enlistment or appointment date:
Tricare Prime Copay For Ct Scan
- Group A: Sponsor's enlistment or appointment date occurred prior to Jan. 1, 2018.
- Group B: Sponsor's enlistment or appointment date occurred on or after Jan. 1, 2018.
TRICARE Prime and TRICARE Prime Remote (not including TRICARE Young Adult)
| Active Duty Family Members | Retirees and Their Family Members |
|---|---|
Group A: $0 Group B: $0 | Group A: $63 Group B: $63 |
TRICARE Select (not including TRICARE Young Adult)
| Active Duty Family Members | Retirees and Their Family Members |
|---|---|
Group A: Network Provider: $93 Group B: Network Provider: $42 | Group A: Network Provider: $125 Group B: Network Provider: $84 |
TRICARE Reserve Select (TRS) and TRICARE Retired Reserve (TRR)
Tricare Prime Copay 2019
| TRS | TRR |
|---|---|
| Network Provider: $42 Non-Network Provider: 20% | Network Provider: $84 Non-Network Provider: 25% |
Tricare Prime Copay 2021
TRICARE Young Adult (TYA)
| TYA Prime | TYA Select | ||
|---|---|---|---|
| Active Duty Family Members | Retiree Family Members | Active Duty Family Members | Retiree Family Members |
| $0 | $63 | Network Provider: $42 Non-Network Provider: 20% | Network Provider: $84 Non-Network Provider: 25% |