Tricare Prescription Drug Costs Won’t Rise in 2021

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Prescription pill bottles
Prescription pill bottles sit on a shelf, Oct. 23, 2020, at Beale Air force Base, California. (Luis A. Ruiz-Vazquez/U.S. Air Force)

Some good news for Tricare beneficiaries facing increasing costs in Tricare enrollment fees and premiums, next year: Your prescription drug costs will not change.

Under the fiscal 2018 National Defense Authorization Act, copayments for medications available at retail pharmacies and through the Tricare mail-order system will not increase next year. Under the fee structure, 30-day prescriptions at Tricare network pharmacies for generic drugs will remain at $13, and for brand names, $33.

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Copayments for prescriptions available through Tricare's home delivery program also will remain the same, a 90-day supply of a generic drug delivered by mail will be $10, a brand-name medication, $29 for a 90-day prescription, and $60 for a medication not listed in the Tricare formulary.

Prescriptions remain available to no cost for those who can use a pharmacy at a military treatment facility.

The fiscal 2018 defense policy bill set the rates for Tricare pharmacy copayments through 2027. By law, they will increase next year by $1 to $8, depending on the type of prescription, unless Congress changes the fee schedule.

The stabilization for 2021, also set by law, comes on the heels of a 2020 increase that took many military retirees by surprise. That spike raised each quantity and drug category by several dollars per refill.

Earlier this year, Defense Department health officials announced that most retirees using Tricare Select will be required to pay enrollment fees for the health program beginning in January. Military retirees under age 65 who joined the military before 2018 will pay an annual enrollment fee of $150 for an individual, or $12.50 per month, or $300 ($25 per month) for a family.

Until now, they have been required to make copayments and cost shares as well as some hospitalization and other fees for health services, but no enrollment fees. The new fees were set into law by the fiscal 2017 National Defense Authorization Act but they were delayed until 2021.

On Monday, Sen. Jon Tester of Montana, the ranking Democrat on the Senate Veterans Affairs Committee and member of the committee that funds U.S. military construction and VA, wrote a letter to Department of Defense Secretary Mark Esper urging DoD to give retirees a grace period during the COVID-19 pandemic.

Saying that the coronavirus has had "unprecedented impacts on the health and economy of our nation," Tester asked Esper to implement a 12-month grace period to ensure that military retirees and their families who use Select have time to meet the new payment requirements.

"No military retiree or their loved ones should be at risk of losing their health care coverage and not receiving the care they need in the midst of this pandemic," Tester wrote.

DoD is required by law to implement the new fees this year, but Tester said it is unlikely Congress could change the requirement before the end of the year. He noted that it is within Esper's authority to delay implementation.

The Defense Health Agency also announced Monday that military dependents who use Tricare Young Adult for their health coverage will see their health care costs rise next year. Monthly premiums for those on TYA Prime will increase by $83, to $459, and for those on TYA Select, by $29, to $257.

Enrollment fees for retirees and their family members who use Tricare Prime, as well as premiums, catastrophic caps, deductibles and copays for other Tricare programs have yet to be announced for 2021. These fees are based on the annual retiree cost-of-living adjustment, or COLA, which was projected to be 1.3% as of late summer.

Tricare officials said any new out-of-pocket expenses determined by the COLA increase will be published before the start of open enrollment Nov. 9. The enrollment window closes Dec. 14.

-- Patricia Kime can be reached at Patricia.Kime@Monster.com. Follow her on Twitter @patriciakime.

Related: Tricare Young Adult Premiums to Rise Sharply in 2021

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