Tricare copays for many drugs will rise again in 2024 as part of a long-term plan to ratchet up patients' share of the costs through 2027. Congress ordered the series of rate hikes that began in 2018.
The rates, which will go up as much as $8 for a 30-day supply of drugs not on Tricare's coverage list, also known as "non-formulary," were published in a Defense Department reimbursement guide on Thursday. Generic drugs and brand-name medication on the coverage list will also see price increases.
Prescription medications filled at on-base pharmacies will remain free.
The changes impact all non-active-duty Tricare users, including those enrolled in Tricare for Life.
Currently, copays for a 30-day prescription at a retail pharmacy are $14 for generic drugs and $38 for brand name. For a 90-day supply through Express Scripts, Tricare's mail order service, copays are $12 for generic drugs and $34 for brand name. Non-formulary drugs are $68 for either the 30-day retail or 90-day, mail-order prescriptions.
In 2024, the rates for 30-day retail prescriptions will go up to $16 for generic drugs and $43 for name brand. For a 90-day, mail-order supply, copays will be $13 for generic drugs and $38 for brand name. Non-formulary drugs will be $76 for either the 30-day retail or 90-day, mail-order prescription.
Rates will go up again in 2026, with 30-day retail prescriptions staying at $16 for generic drugs but rising to $48 for brand name. The copays for 90-day, mail-order supplies will go up to $14 for generic drugs and $44 for brand name. Non-formulary drugs will then be $85 for either the 30-day retail or 90-day, mail-order prescription.
After 2027, the defense secretary will have the authority to adjust the copays "to reflect changes in the costs of pharmaceutical agents and prescription dispensing," according to the 2018 National Defense Authorization Act.
Congress ordered the rate hikes to pay for a separate benefit. It needed to come up with an estimated $1 billion a year to eliminate the so-called "widow's tax," known formally as the Survivor Benefit Plan (SBP) Offset.
Until 2020, the surviving beneficiaries of service members who died from a service-related cause couldn't receive the full amount of two survivor benefits at the same time. The rule had reduced their SBP payments by subtracting the amount they received from the Department of Veterans Affairs' Dependency and Indemnity Compensation (DIC) program.
The offset was completely eliminated as of February.
As the Defense Department gradually eliminated the widow's tax, it also incrementally increased the cost of prescriptions. Before the prescription copays started going up in 2018, a 90-day, mail-order supply of a generic drug was free.
-- Amanda Miller can be reached at amanda.miller@military.com.
