TRICARE Coverage for Generics: Military Health Insurance Drug Costs and Access

When you're in the military or a family member of someone who is, getting your prescriptions shouldn't be a hassle. But understanding how TRICARE covers generic drugs can be confusing. The good news? Most of the time, you're paying way less than civilians do-especially if you use a military pharmacy. Here's how it really works, down to the copay amounts, what’s covered, and what trips people up.

What TRICARE Covers: The Formulary System

TRICARE doesn’t cover every drug out there. Instead, it uses a list called the formulary. This list includes about 5,500 medications approved by the FDA, split into four tiers. The first tier is where you’ll find most generic drugs. These are exact copies of brand-name medications-same active ingredients, same effectiveness-but they cost 80-85% less. That’s why TRICARE pushes them hard. In fact, 92% of all prescriptions filled through TRICARE in 2025 were for generics.

But here’s the catch: just because a drug is generic doesn’t mean it’s automatically on the formulary. About 12% of generic medications require prior authorization before TRICARE will pay. That means your doctor has to prove it’s medically necessary. If you’re prescribed a generic that’s not on the list, you might have to wait 48 hours-or longer-for approval.

Where You Fill Your Prescriptions: Three Options

You have three ways to get your generic meds under TRICARE, and each has a different cost:

• Military pharmacies: These are on base, run by the Defense Health Agency. Fill your prescription here, and you pay $0-no matter what drug it is. This is the best deal you’ll find anywhere. Active duty service members use this option 76% of the time.
• TRICARE Home Delivery: This is Express Scripts’ mail-order service. You order a 90-day supply, and it ships to your door. In 2025, the copay is $13. Starting January 1, 2026, it goes up to $14. That’s still cheaper than most civilian plans, where a 30-day supply of the same generic can cost $20-$30.
• Network retail pharmacies: Think CVS, Walgreens, or local pharmacies that accept TRICARE. For a 30-day supply of a generic, you pay $16 in 2025 and 2026. It’s immediate, but more expensive than home delivery.

For retirees and families, home delivery is becoming the go-to. In 2020, only 41% of TRICARE users used it. By 2025, that number jumped to 58%. Why? Convenience and cost. Getting 90 days of medication for $13-$14 saves trips, time, and money.

What Happens If Your Drug Isn’t on the Formulary?

Not every generic makes the cut. Some are left off because there’s a cheaper alternative, or because TRICARE’s pharmacy experts don’t see enough clinical advantage. If your doctor prescribes one of these, you’ll need to file a medical necessity request. In 2024, 78% of these requests were approved. But the process isn’t instant. You’ll likely need to wait a few days, and sometimes your provider has to submit extra paperwork.

One common pain point? Weight loss medications. As of August 31, 2025, TRICARE For Life beneficiaries (mostly retirees over 65) can no longer get coverage for generic weight loss drugs-even though the FDA approved them. Around 1.2 million people are affected. Some call it a gap. Others say it’s about cost control. Either way, it’s a real issue for older beneficiaries managing obesity-related conditions.

How TRICARE Compares to Other Programs

Let’s put this in perspective. Medicare Part D plans average $7-$10 copays for generics. So why does TRICARE charge $13-$16? Because TRICARE offers something Medicare doesn’t: free fills at military pharmacies. If you live near a base, you’re better off than most civilians.

Compare that to the VA, which gives veterans free prescriptions with no copays. TRICARE doesn’t go that far-except for active duty members. For retirees and families, there’s a trade-off: slightly higher copays at retail, but way more drug options and better access to specialists.

TRICARE ranks third among U.S. government health programs for generic drug access, behind Medicare Advantage but ahead of Medicaid. It’s not perfect, but it’s solid. The 2025 beneficiary survey showed 86% satisfaction with generic access. People who use military pharmacies or home delivery report the highest satisfaction.

Real-World Experience: What Users Say

Reddit threads and military forums are full of stories. One Marine Corps retiree wrote: “My generic cholesterol pill costs $14 for 90 days through home delivery. My civilian friends pay $30 for 30 days. I’m not complaining.”

Another user on Military OneSource said: “My doctor prescribed a generic for my blood pressure, but it wasn’t on the formulary. I had to go back to the clinic three days later after they approved it. Frustrating, but worth it.”

Most complaints center around delays in prior authorization and inconsistent pharmacy staff knowledge. One user noted: “The pharmacist at my local CVS didn’t even know how to process my TRICARE claim. I had to call the helpline.”

How to Check If Your Drug Is Covered

Don’t guess. Use the TRICARE Formulary Search Tool. Type in the exact drug name and strength. It’ll tell you:

• Which tier it’s on
• What your copay will be
• Whether prior authorization is needed
• Which pharmacy option is cheapest

The tool was updated in February 2025 to show real-time cost estimates. It’s mobile-friendly and works even if you’re overseas. Bookmark it. Use it before your doctor writes the script.

What’s Changing in 2026

The biggest update? The $1 increase on home delivery generics-from $13 to $14. That’s the first change since 2023. Retail copays stay at $16. Experts say this won’t hurt adherence. A pilot study showed only a 0.8% drop in fills after similar increases.

Also coming in 2026: real-time benefit tools. This means your doctor will see your TRICARE coverage and cost right when they write the prescription. No more surprises at the pharmacy. By 2028, TRICARE plans to test genetic testing for certain high-risk medications to personalize dosing.

Pro Tips to Save More

• If you’re active duty: Always use the military pharmacy. It’s free. No exceptions.
• If you’re a retiree or family member: Use home delivery for maintenance meds. 90-day supplies cut your trips and lower your per-day cost.
• Check the formulary before each refill. Drugs get added and removed monthly.
• If a generic isn’t covered, ask your doctor for a therapeutic alternative. Often, there’s another generic on the formulary that works just as well.
• Call the TRICARE Pharmacy Helpline (1-877-363-1303) if you’re confused. They handled 1.2 million calls in 2025.

TRICARE’s system isn’t perfect, but it’s designed to keep you healthy without breaking the bank. The program saves $1.7 billion a year by favoring generics. And for most people, that translates to real savings-$0 copays, $14 for 90 days, or $16 for 30. That’s better than most private insurance.