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Increases to TRICARE pharmacy copayments coming

TRICARE urges you to take command of your health care to enhance your TRICARE experience. TRICARE is changing. Are you ready?

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TRICARE Pharmacy Program | TRICARE Formulary

On Feb 1, 2018, copayments for prescription drugs at TRICARE Pharmacy Home Delivery and retail pharmacies will increase. These changes are required by law and affect TRICARE beneficiaries who are not active duty service members.

While retail pharmacy and home delivery copayments will increase, prescriptions filled at military pharmacies remain available at no cost. You can save the most money by filling your prescriptions at military pharmacies.

“Military pharmacies and TRICARE Pharmacy Home Delivery will remain the lowest cost pharmacy option for TRICARE beneficiaries,” said U.S. Air Force Lt. Col. Ann McManis, Pharmacy Operations Division at the Defense Health Agency.

Using home delivery, the copayments for a 90-day supply of generic formulary drugs will increase from $0 to $7. For brand-name formulary drugs, copayments will increase from $20 to $24, and copayments for non-formulary drugs. without a medical necessity will increase from $49 to $53.

At a retail network pharmacy, copayments for a 30-day supply of generic formulary drugs will increase from $10 to $11 and from $24 to $28 for brand-name formulary drugs.

In some cases, survivors of active duty service members may be eligible for lower cost-sharing amounts.

TRICARE groups pharmacy drugs into three categories: generic formulary, brand name formulary and non-formulary. You pay the least for generic formulary drugs and the most for non-formulary drugs, regardless of whether you get them from home delivery or a retail pharmacy.

To see the new TRICARE pharmacy copayments, visit www.tricare.mil/. To learn more about the TRICARE Pharmacy Program, or move your prescriptions to home delivery, visit www.tricare.mil/pharmacy.  

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This Defense Health Agency-Procedural Instruction (DHA-PI): a. Based on the authority of References (a) through (c), and in accordance with the guidance of References (d) through (g), establishes the Defense Health Agency’s (DHA) procedures to: (1) Exercise management responsibilities for Pharmacy Shared Service/EA functions in the Military Health System (MHS). This DHA-PI is binding on the MHS and supports the Director’s, DHA, responsibility to develop appropriate management models to maximize efficiencies in the activities carried out by DHA. (2) Recognize the Pharmacy Work Group (PWG) as the operational body to implement pharmacy strategies and programs per the Director’s, DHA, guidance. Also, develop strategic initiatives and business process models to optimize pharmacy operations and programs in accordance with Reference (e). (3) Promulgate guidance, define roles, assign responsibilities, and prescribe procedures for the development, coordination, execution, and implementation of standardized Pharmacy Operations and EA procedures within the MHS and Military Departments (MILDEPs). (4) Execute Pharmacy EA assigned responsibilities and functions, and in accordance with Reference (b), when needed, rely on advice and assistance of governance councils established by the Under Secretary of Defense for Personnel and Readiness and the Assistant Secretary of Defense for Health Affairs (ASD(HA)), including senior representatives of the MILDEPs. (5) Provide DHA combat support agency pharmacy functions, in accordance with Reference (b), specifically involving support for operating forces engaged in planning for, or conducting, military operations, including support during conflict or in the conduct of other military activities related to countering threats to U.S. National Security. The Pharmacy EA innovatively manages and standardizes DoD pharmacy operations in a fiscally responsible manner to optimize readiness, improve health, and lower costs through better care. (6) Support baseline knowledge, skills, and abilities for each wartime pharmacy specialty, addressing gaps between peacetime and deployed operational requirements, in collaboration with the MILDEPs, and military Medical Treatment Facility (MTF) pharmacies. (7) Support programs for skills and knowledge assessments and provide for training/retraining opportunities, as needed, for each wartime pharmacy specialty for military MTF pharmacies. (8) Empower enterprise-level pharmacy clinical communities to define, prioritize, and implement “best-in-class” High Reliability Organization practices to enable readiness through decreasing variation, improving outcomes, and positively impacting healthcare in the MHS. (9) Support the scaling and reconfiguring of pharmacy capabilities required to support the forward operating environment; e.g., hospital ship, combat support hospitals, Expeditionary Medical Support. The Services’ Surgeons General will have deployed medical mission command over health services support of pharmacy resources and capabilities at various levels of command and at diverse locations. b. Transforms varied Tri-Service Pharmacy Operations approaches into a single, integrated DHA Pharmacy Program that standardizes pharmacy shared services and optimizes business processes as directed by the National Defense Authorization Act for Fiscal Year 2017, Section 702 (Reference (c)). c. Drives standardization of institutional and operational commands, sustains and improves medical readiness, creates value within the MHS, and achieves interoperability across platforms to deliver better health care to the warfighter, MHS beneficiaries, and build a medically ready force.

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Increases to TRICARE pharmacy copayments coming Feb. 1, 2018

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12/18/2017
TRICARE urges you to take command of your health care to enhance your TRICARE experience.

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  • Date: 3/22/2005
  • Type: Memorandums
  • Topics: TRICARE Formulary
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