Covered Services
Chart does not include using non-network retail pharmacies and represents the TRICARE copayments effective as of January 1, 2019. Using Home Delivery with Other Health Insurance (OHI) In addition to TRICARE, many beneficiaries have additional insurance coverage, often through their employer, Medicare Part D, or another private insurance program. The additional 15 percent non-participating providers may charge above the TRICARE allowable charge. If the beneficiary changes programs during the calendar year under the same sponsor, any amount credited toward the catastrophic cap will roll over to the new program (does not apply to Continued Health Care Benefit Program CHCBP).
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
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
Examples of commercial insurance include PPO, HMO, or COBRA through your or your spouse's employer or a private insurance carrier. What you pay for Repatha® will vary depending on your insurance plan.
88% of Repatha® prescriptions cost patients less than $50 per month.1,*
Repatha® Copay Card
With the Repatha® Copay Card, eligible commercially insured patients may pay $5 per month.†
Tricare Cost Share 2021
Click here to learn more about the Repatha® Copay Card.
*Based on IQVIA claims data from Commercial, Medicare, and Medicaid claims from 01/2020 to 08/2020.
Tricare Copayments
†Eligibility Information and Repatha® Copay Program Terms & Conditions. Open to patients with commercial prescription insurance and who are not enrolled in any government-funded program that pays for prescription drugs. This program is not open to uninsured patients or patients enrolled in any federal-, state-, or government-funded healthcare program such as Medicare, Medicare Advantage, Medicare Part D, the Retiree Drug Subsidy Program, Medicaid, Medigap, Veterans Affairs (VA), the Department of Defense (DoD), or TRICARE® or where prohibited by law. Cash Discount Cards and other noninsurance plans may not be used as primary insurance coverage under this offer. Other restrictions, including annual copay maximum limits may apply. This offer is subject to change or discontinuation without notice.
Tricare Prime Cost 2021
If at any time a patient becomes enrolled under any such federal, state, or government-funded healthcare program, he/she will no longer be able to use this card and must call 1-844-REPATHA to stop participation. Restrictions may apply. Offer subject to change or discontinuation without notice. See below for full terms and conditions. This is not health insurance. Patients under 18 years of age are not eligible for this program.