![]() The purpose of this article is to discuss the changes to the TRICARE pharmacy benefit, describe the continual challenges, and estimate cost savings associated with implementation of these changes.ĭoD implemented its 3-tier Uniform Formulary in 2005. Several initiatives have resulted in significant cost avoidance to the Department of Defense (DoD). These changes include assigning newly approved drugs to nonformulary status after regulatory approval, the addition of weight loss medications to the benefit, channel management point-of-service requirements for some medications, and copay increases. The TRICARE pharmacy benefit has undergone many changes in the last decade. TRICARE is the military’s health plan that provides coverage to 9.4 million active duty and retired uniformed services personnel and their family members. There’s still no cost for covered generic and brand-name drugs at military pharmacies.įor questions about TRICARE pharmacy benefits, visit. Keep in mind, using a military pharmacy remains the lowest cost option. Non-formulary drugs will cost $68 (up from $60) or 20% of the total cost, whichever is more, after meeting the annual deductible.Generic formulary drugs and brand-name formulary drugs will cost $38 (up from $33) or 20% of the total cost, whichever is more, after meeting the annual deductible.For all other health plans, non-network pharmacy costs are as follows: With a TRICARE Prime plan, there is a 50% cost-share after meeting the point-of-service deductible for covered drugs. Non-network pharmacy costs remain the same for those with a TRICARE Prime plan. ![]() Non-network pharmacies (up to a 30-day supply) This doesn’t apply to filling short-term use drugs at retail network pharmacies. After the second refill, beneficiaries must use home delivery or a military pharmacy. These are drugs taken for long-term conditions. It’s important to note that some brand-name maintenance drugs can only be filled twice at retail network pharmacies. Brand-name formulary drugs will increase from $33 to $38.Generic formulary drugs will increase from $13 to $14.TRICARE retail network pharmacies (up to a 30-day supply) Non-formulary drugs will increase from $60 to $68.Brand-name formulary drugs will increase from $29 to $34.Generic formulary drugs will increase from $10 to $12.TRICARE Pharmacy Home Delivery (up to a 90-day supply) The new cost will depend on the type of pharmacy. ![]() There will be cost increases in all three of these categories. This is followed by brand-name formulary drugs and non-formulary drugs. The cheapest, most widely available category is generic formulary drugs. Medically retired service members and their family members also won’t see a change in their copayments next year.Īs described in the TRICARE Pharmacy Program Overview, TRICARE groups prescription drugs are based on the medical and cost effectiveness of a drug compared to other drugs of the same type. Copayments for survivors of ADSMs will remain the same. Active-duty service members (ADSM) will not pay for drugs at military pharmacies, retail network pharmacies and through home delivery. These costs changes won’t affect all beneficiaries. “The changes are part of a larger effort to help fund improvements in military readiness and modernize the TRICARE health care benefit.” Public Health Service Commander Teisha Robertson, a pharmacist with the Defense Health Agency’s Pharmacy Operations Division. “Congress and the Department of Defense worked together on these cost changes as part of the National Defense Authorization Act for Fiscal Year 2018,” said U.S. Beneficiaries who receive prescription drugs through TRICARE Pharmacy Home Delivery or at a TRICARE retail network pharmacy will pay anywhere from $1 to $8 more in copayments starting Jan.
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