Military Advantage

TRICARE Co-Pays Likely to Increase


In addition to the DoD proposal to increase TRICARE Prime enrollment fees for military retirees under 65, the 2012 Budget proposal includes a plan to increase co-pays on prescription medications.

Under the proposed 2012 budget, TRICARE prescriptions filled on base will remain free, but, co-pays for medications purchased at retail pharmacies will increase. DoD is hoping that the increased co-pays will encourage beneficiaries to use TRICARE's mail-order "home delivery" option. 

If passed the current $3 co-pay for generics at retail outlets will increase to $5 and the $9 co-pays for brand name drugs will climb to $12. "Tier 3" (non-formulary brand) drugs, which currently cost beneficiaries a $22 co-pay will be raised to $25 for both mail order and retail. In addition, the plan would remove the $3 charge for mail order generic drugs. The new co-pays could save the DoD $2.6 billion over five years.

Read Tom Philpott's Military Update to learn more.

Here is a chart comparing the current and proposed TRICARE co-pays.

  Generic Brand Formulary Tier 3 (Non-Formulary)
  Current Benefit
Retail  $3 $9 $22
On-Base  $ - $ - $ -
Mail Order  $3 $9 $22
  Proposed Benefit
Retail  $5 $12 $25
On-Base  $ - $ - $ -
Mail Order  $ - $9 $25
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