Pharmacy Copayments
On January 1, 2022 changes in pharmacy copays for military health plans took effect.
Please note: Pharmacy copay changes do not affect dependent survivors of active duty service members. They also do not affect medically retired service members and their dependents.
These changes are required by law and affect TRICARE beneficiaries. The new copays are listed in the chart below:
| Copay Tier | Pharmacy | Cost Rx per Fill | Average Cost Per Year |
|---|---|---|---|
|
Tier 1 Formulary Generics |
Mail-Order and PacMed Pharmacy | $12 | $48 |
| Network Pharmacy | $14 | $168 | |
|
Tier 2 Formulary Brands |
Mail-Order and PacMed Pharmacy | $34 | $136 |
| Network Pharmacy | $38 | $456 | |
|
Tier 3 Non-Formulary |
Mail-Order and PacMed Pharmacy | $68 | $272 |
| Network Pharmacy | $68 | $816 | |
|
Non-Covered Drugs Tier 4 |
Full Cost of Drug |
Full Cost of Drug |
Source: www.tricare.mil/Costs
Prescriptions filled at mail order will have lower copays than those picked up at your local pharmacy. MXP MaxorPlus Pharmacy handles your USFHP mail order service. If you are not using mail order but would like to, it is easy to do. To transfer your prescriptions to mail order, call MXP MaxorPlus Pharmacy customer service at 866-408-2459.
These price increases were mandated by Congress. They were part of the National Defense Authorization Act for Fiscal Year 2018. The changes aim to bring the amount TRICARE beneficiaries pay in line with the actual costs of prescription drugs.