Jan 29 2013
The new copayments for prescription drugs covered by TRICARE will go into effect Friday February 1, 2013. The Fiscal Year 2013 National Defense Authorization Act requires TRICARE to increase copays on brand name and non-formulary medications that are not filled at military clinics or hospitals. There is no increase to copays for generic medications.
By way of history, while not a fan of raising rates, we did recognize that these adjustments were the “lesser of the evils” which otherwise would have been foisted upon us. We supported the fact that for fiscal 2014 and beyond, the new law which directs that copays increase annually by only the same percentage as retiree cost of living adjustments. In years when a COLA increase would total less than a dollar, it will be delayed a year and combined with the next adjustment so increases will always be $1 or more.
TRICARE Pharmacy copays vary based on the class of drug and where beneficiaries choose to fill their prescriptions. The copay for generic medications stays at $5 when a prescription is filled at a network pharmacy. There is no co-pay when generic prescriptions are filled through TRICARE Home Delivery. The new copay for a 30-day supply of a brand name medication purchased at a retail network pharmacy will be $17, up from the current $12. Beneficiaries using TRICARE Home Delivery will pay $13 for brand name drugs, up from $9. However, the Home Delivery price is for a 90-day supply.
The greatest change in copays applies to non-formulary medications. The $25 copay for these drugs increases to $44 at retail pharmacies and $43 through Home Delivery. The TRICARE Uniform Formulary is a list of all the medications TRICARE covers.
Pharmacies at military hospitals and clinics will continue to provide medications with no copays.
Additionally, we have received numerous inquiries regarding the start-up of one of the other key 2013 legislative provisions – the mandatory home delivery of maintenance medications for TFL beneficiaries.
Recall that this provision requires a 5 year pilot program that requires beneficiaries to receive certain maintenance medications for a trial period of 1 year (with the option to opt out after that period if so desired).
In our discussions with TRICARE pharmacy leadership, we understand that the development of the implementation and execution plans will take some time. Our best forecast at this juncture, is that the program will start in the summer or early fall 2013 time frame. MOAA is planning to participate in this process by offering the perspectives of the beneficiary.
So stay tuned, more to come!
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