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Proposed TRICARE Fee Changes

TRICARE Pharmacy Costs

Proposed Changes to TRICARE Fees

The following tables reflect the proposed changes to TRICARE fees, deductibles, and co-pays for Fiscal Year 2013 through 2017. The enrollment fees and deductible changes would affect military retirees only. The changes to TRICARE Pharmacy co-pays would affect all TRICARE beneficiaries.

Proposed TRICARE Prime Annual Family Enrollment Fees (Individual Fees are 50%) for Working-Age Retirees


Retired Pay Tiers

FY 2012

FY 2013

FY 2014

FY 2015

FY 2016*

FY 2017

Tier 1:
$0 – $22,589

$460/$520

$600

$680

$760

$850

$893

Tier 2:
$22,590 – $45,178

$460/$520

$720

$920

$1,185

$1,450

$1,523

Tier 3:
Over $45,178

$460/$520

$820

$1,120

$1,535

$1,950

$2,048

*Indexed to medical inflation (National Health Expenditures) after FY 2016.

Proposed TRICARE Standard/Extra Fees/Deductibles for Working-Age Retirees


Annual Enrollment Fees

FY 2012

FY 2013

FY 2014

FY 2015

FY 2016

FY 2017*

Individual

$0

$70

$85

$100

$115

$130

Family

$0

$140

$170

$200

$230

$250

 

Annual Deductibles

 

Individual

$150

$160

$200

$230

$260

$290

Family

$300

$320

$400

$460

$520

$580

*Indexed to medical inflation (National Health Expenditures) after FY 2017.

Proposed TRICARE-for-Life  (TFL) Annual Enrollment Fees – Per Individual


Retired Pay Tiers

FY 2012

FY 2013

FY 2014

FY 2015

FY 2016*

FY 2017

Tier 1:
$0 – $22,589

$0

$35

$75

$115

$150

$158

Tier 2:
$22,590 – $45,178

$0

$75

$150

$225

$300

$317

Tier 3:
Over $45,178

$0

$115

$225

$335

$450

$475

*Indexed to medical inflation (National Health Expenditures) after FY 2016.

 

Proposed Pharmacy Co-Pays for All TRICARE Beneficiaries


RX Source

FY 2012

FY 2013

FY 2014

FY 2015

FY 2016

FY 2017

Retail – 1 month fill

 

Generic

$5

$5

$6

$7

$8

$9

Brand Name

$12

$26

$28

$30

$32

$34

Non-Formulary*

$25

N/A

N/A

N/A

N/A

N/A

 

 

Mail-Order – 3 month fill

 

 

 

 

 

 

Generic

$0

$0

$0

$0

$0

$9

Brand

$9

$26

$28

$30

$32

$34

Non-Formulary

$25

$51

$54

$58

$62

$66

 

Military Treatment Facilities

No Change – Remains $0 Co-Pay

* Non-Formulary pharmaceuticals will have limited availability in retail pharmacies

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