Editor’s Note: This article is part of MOAA’s 2026-27 TRICARE Guide, brought to you by MOAA Insurance Plans, administered by Association Member Benefits Advisors (AMBA). A version of the guide appeared in the November 2026 issue of Military Officer magazine.
Protecting affordable access to prescription medications will remain one of MOAA’s top legislative priorities in the 120th Congress as lawmakers consider the future of TRICARE’s pharmacy benefit.
For years, a congressionally directed schedule established in the FY 2018 National Defense Authorization Act (NDAA) has governed copays for TRICARE prescription drugs. That schedule expires after 2027. Beginning in 2028, the same law gives the Pentagon authority to adjust pharmacy copays to reflect changes in pharmaceutical and dispensing costs.
While there is no indication the Pentagon intends to propose significant increases, the authority exists, and Congress must understand the implications before any future TRICARE pharmacy copay proposals come under consideration.
MOAA Advocates for You
MOAA’s mission is to preserve and protect the earned benefits of the uniformed services community. For Medicare-eligible beneficiaries, the military health care benefit established by Congress is TRICARE For Life (TFL), which provides Medicare-wraparound coverage along with access to the TRICARE pharmacy program.
Like all Medicare beneficiaries, military retirees are responsible for paying Medicare Part B premiums and, for higher-income individuals, the income-related monthly adjustment amount (IRMAA). These costs apply broadly to Americans based on the laws governing Medicare.
MOAA’s advocacy efforts focus on protecting and sustaining earned benefits. That includes defending TFL, preserving affordable access to prescription drugs, and opposing proposals that would shift disproportionate health care costs onto beneficiaries.
Exempting retirees of the uniformed services from Medicare Part B premiums or IRMAA would represent a new benefit beyond the military health care benefit as defined in law. By remaining focused on protecting earned benefits and addressing proposals that directly impact the military health system, MOAA is best positioned to advocate effectively on behalf of the 9.5 million beneficiaries who rely on TRICARE.
– MOAA Staff
Over the coming year, MOAA will work to raise awareness among lawmakers as well as the military and veteran communities about this little-known provision of law. Understanding the risks associated with this provision before it becomes an urgent issue will help Congress evaluate future proposals for changing TRICARE pharmacy copays.
Congress created TRICARE’s integrated pharmacy benefit more than two decades ago, giving beneficiaries access to prescriptions through pharmacies at military treatment facilities (MTFs), home delivery, and the retail pharmacy network.
TRICARE For Life legislation enacted in the FY 2001 NDAA expanded home delivery and retail pharmacy access to Medicare-eligible retirees who previously relied exclusively on MTFs.
[RELATED: 4 Priorities for a Stronger TRICARE Pharmacy Program]
Initial TRICARE pharmacy copays established by the Pentagon followed legislative intent and were aligned with commercial plan benchmarks. Since then, Congress has regularly intervened in setting pharmacy copays. Most recently, the FY 2018 NDAA established biennial increases through 2027 that have generally kept TRICARE cost sharing in line with employer-sponsored plans.
According to the Kaiser Family Foundation’s 2025 Employer Health Benefits Survey, the average retail copays for first-, second-, and third-tier prescription drugs are $12, $40, and $71, respectively. Current TRICARE retail pharmacy copays are $16 for generic drugs, $48 for brand name drugs, and $85 for non-formulary drugs for up to a 30-day supply.
Through TRICARE Home Delivery, beneficiaries pay $14 for generics, $44 for brand name drugs, and $85 for nonformulary medications for up to a 90-day supply. Prescriptions filled at MTF pharmacies remain free, as do all prescriptions for active duty servicemembers regardless of where they are filled.
[RELATED: NDAA Provision Would Help Remove Health Care Barriers]
The survey also illustrates how commercial prescription drug benefits continue to evolve.
Many employer-sponsored plans now include separate cost-sharing tiers for specialty medications while others reduce or eliminate copays for medications that help manage chronic conditions. Approximately 63% of workers at large firms are enrolled in plans with a separate specialty drug tier, where the average copay is $123 and average coinsurance is 31%. TRICARE has not adopted either approach.
MOAA will provide updates as we work to inform lawmakers about the importance of preserving the TRICARE pharmacy benefit for the military community before future TRICARE pharmacy copay proposals are released.
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