TRICARE Prescription Coverage: Why Copays Are Going Up...Again
TRICARE Prescription Coverage: Why Copays Are Going Up...Again
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TRICARE Prescription Coverage: Why Copays Are Going Up...Again

November 8, 2021

Your TRICARE prescription coverage copays are about to increase. If you or anyone in your family ever needs prescription medications, this is new you need to pay attention to.

The Planned Price Hike

TRICARE has announced that TRICARE enrollees will pay between $1 and $8 more for each prescription filled in 2022. The prescription coverage price hike will go into effect on January 1, 2022. 

Exactly how much more you’ll pay will depend on both the type of prescription drug and how you fill it. Here’s how much you’ll be paying using TRICARE Pharmacy Home Delivery or TRICARE retail network pharmacies:

  • Generic formulary drugs filled through TRICARE Pharmacy Home Delivery will increase $2, from $10 to $12.
  • Generic formulary drugs filled through TRICARE retail network pharmacies will increase $1, from $13 to $14.
  • Brand-name formulary drugs filled through TRICARE Pharmacy Home Delivery will increase $5, from $29 to $34.
  • Brand-name formulary drugs filled through TRICARE retail network pharmacies will increase $5, from $33 to $38.
  • Non-formulary drugs filled through TRICARE Pharmacy Home Delivery will increase $8, from $60 to $68.
  • Non-formulary drugs filled through TRICARE retail network pharmacies will increase $8, from $60 to $68.

If you have a TRICARE Prime plan, your non-network pharmacy costs will not change in 2022. This means you’ll still be paying 50% after you meet your annual deductible. However, if you have a TRICARE plan other than TRICARE Prime, your non-network pharmacy costs will be increasing in 2022. Generic and brand-name formulary drugs will cost 20% of the total cost or $38, whichever is greater, after the annual deductible is met. Non-formulary drugs will cost 20% of the total cost or $68, whichever is greater, after the annual deductible is met.

Why Are Costs Increasing?

According to the TRICARE website, the new price hikes have been planned for a while. The change is part of the National Defense Authorization Act for Fiscal Year 2018.

U.S. Public Health Service Cmdr. Teisha Robertson says that the increases “are part of a larger effort to help fund improvements in military readiness and modernize the TRICARE health care benefit.”

Unfortunately, the hikes come at a bad time for many American families. Prescription drugs aren’t the only item that’s getting more expensive. Inflation has been high; CBS News says consumer prices increased 5.4% in September, the fastest rate seen in 13 years. Rising food and shelter costs are responsible for more than half of the overall cost increases.

This Isn't the First – or Last – TRICARE Prescription Coverage Increase

If news of a TRICARE prescription copay increase sounds familiar, don’t worry. You’re not imagining things. Prescription drug copays also increased in 2020. Back in 2019, TRICARE announced that people using TRICARE Pharmacy Home Delivery or TRICARE retail network pharmacies would pay $2 to $7 more per prescription starting on January 1, 2020. This increase was also part of the National Defense Authorization Act for Fiscal Year 2018.

Federal News Network says that more price increases are expected in the years to come.

How Can Families Prepare?

Necessities are getting more expensive. Between the new prescription drug copays and the widespread inflation, the average family’s budget will need to stretch further. It’s time to take a serious look at your budget. If the numbers don’t add up, something will need to change.

For families enrolled in TRICARE, a TRICARE Supplement may help.

TRICARE Supplement plans are designed to wrap around TRICARE plans. You have to pay the premium and deductible, but after that, the TRICARE Supplement plan can pay for up to 100% of the additional costs that the TRICARE plan leaves behind, including prescription copays.

If your family expects to have high prescription costs in the coming year, a TRICARE Supplement plan may make sense. Even if you don’t think you’ll need expensive prescriptions, a TRICARE Supplement plan may be worthwhile. This is because medical costs can be unpredictable. You never know when an illness or injury will strike, and when it happens, the out-of-pocket costs can be significant. A TRICARE Supplement plan makes your costs predictable, so you never have to lose sleep over the what-ifs.

TRICARE Supplement plans are fully portable, meaning you can keep them even if you change jobs. If you meet the following three criteria, you are eligible to enroll in a TRICARE Supplement plan:

  • You are enrolled in a TRICARE plan.
  • You are not on active duty.
  • You are not eligible for Medicare.

Watch this video to learn more or apply for a TRICARE Supplement plan.

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