TRICARE Pharmacy Copayments/Cost Shares in the United States
(Including Guam, Puerto Rico, the U.S. Virgin Islands, and the Northern Mariana Islands) |
| Formulary | Non-Formulary
(Tier 3) |
| Generic
(Tier 1) | Brand Name
(Tier 2) |
Current Copays
Military Treatment Facility (MTF) Pharmacy
(up to a 90-day supply) | $0 | $0 | Not Applicable MTFs are prohibited under the Code of Federal Regulations from carrying non-formulary medications |
Copays Effective October 1, 2011
MTF Pharmacy
(up to a 90-day supply) | $0 | $0 | Not Applicable MTFs are prohibited under the Code of Federal Regulations from carrying non-formulary medications |
Current Copays
Home Delivery
(up to a 90-day supply) | $3 | $9 | $22 |
Copays Effective October 1, 2011
Home Delivery
(up to a 90-day supply) | $0 | $9 | $25 |
Current Copays
Retail Network Pharmacy
(up to a 30-day supply) | $3 | $9 | $22 |
Copays Effective October 1, 2011
Retail Network Pharmacy
(up to a 30-day supply) | $5 | $12 | $25 |
Current Copays
Non-Network Retail Pharmacy
(up to a 30-day supply)
Note: Beneficiaries using non-network pharmacies may have to pay the total amount of their prescription first and then file a claim to receive partial reimbursement. | Beneficiaries Not enrolled in TRICARE Prime:
$9 or 20% of total cost, whichever is greater, after deductible is met (E1-E4: $50/person; $100/family. All others, including retirees: $150/person; $300/family)
TRICARE Prime Enrollees:
50% cost share after point-of-service deductible ($300/person; $600/family) is met | Beneficiaries Not enrolled in TRICARE Prime:
$22 or 20% of total cost, whichever is greater, after deductible is met (E1-E4: $50/person; $100/family. All others, including retirees: $150/person; $300/family)
TRICARE Prime Enrollees:
50% cost share after point-of-service deductible ($300/person; $600/family) is met |
Copays Effective October 1, 2011
Non-Network Retail Pharmacy
(up to a 30-day supply)
Note: Beneficiaries using non-network pharmacies may have to pay the total amount of their prescription first and then file a claim to receive partial reimbursement. | Beneficiaries Not enrolled in TRICARE Prime:
$12 or 20% of total cost, whichever is greater, after deductible is met (E1-E4: $50/person; $100/family. All others, including retirees: $150/person; $300/family)
TRICARE Prime Enrollees:
50% cost share after point-of-service deductible ($300/person; $600/family) is met | Beneficiaries Not enrolled in TRICARE Prime:
$25 or 20% of total cost, whichever is greater, after deductible is met (E1-E4: $50/person; $100/family. All others, including retirees: $150/person; $300/family)
TRICARE Prime Enrollees:
50% cost share after point-of-service deductible ($300/person; $600/family) is met |