TRICARE Coverage for Generics: What Military Families Need to Know in 2025

When you're on TRICARE, getting your prescriptions filled shouldn't feel like a maze. But if you've ever been surprised by a $48 bill for a generic blood pressure pill, you know it's not always straightforward. The good news? TRICARE covers generics - and does so better than most civilian plans. The catch? Not every generic is automatically covered, and where you fill it makes a huge difference in what you pay.

How TRICARE Handles Generic Drugs

TRICARE doesn't treat all drugs the same. It uses a four-tier system, and generics sit in Tier 1 - the cheapest and most encouraged option. By October 2025, the program covered over 5,500 brand-name and generic medications, with 92% of all prescriptions filled being generics. That’s higher than the national average. Why? Because generics work the same as brand-name drugs but cost 80-85% less. The FDA confirms they’re identical in active ingredients, safety, and effectiveness.

But here’s the thing: just because a drug is generic doesn’t mean it’s on the TRICARE formulary. About 12% of generic medications require prior authorization before they’re covered. That means your doctor has to prove it’s medically necessary - and that can take up to 72 hours. If you’re managing a chronic condition like diabetes or high cholesterol, you’re likely fine. Most Tier 1 generics for these conditions are approved without hassle. But if your doctor prescribes a newer generic or one used off-label, you might get stuck waiting.

Where You Fill Your Prescription Changes Everything

Your out-of-pocket cost for a generic drug depends entirely on where you get it. There are three options:

• Military pharmacies: Zero copay. Always. Whether you’re active duty, a retiree, or a family member, if you walk into a military treatment facility pharmacy, you pay nothing for any covered generic. This is the biggest advantage TRICARE has over Medicare or private insurance.
• TRICARE Home Delivery (Express Scripts): $13 for a 90-day supply through December 31, 2025. Starting January 1, 2026, it goes up to $14. This is the most cost-effective option if you’re on a long-term medication. You get three months’ supply shipped to your door.
• Network retail pharmacies: $16 for a 30-day supply. This rate stays the same through 2026. If you need a refill right away and can’t wait for mail order, this is your go-to - but only if you use a TRICARE-partnered pharmacy like CVS, Walgreens, or Rite Aid.

Outside the network? That’s where things get expensive. If you fill a prescription at a non-network pharmacy in the U.S., you’ll pay either $48 or 20% of the total cost - whichever is higher - after you’ve met your annual deductible. For a $20 generic, that’s $48. For a $100 drug, you pay $20. It’s confusing, and many beneficiaries don’t realize it until they get the bill.

What’s Not Covered - And Why

TRICARE’s formulary isn’t endless. In August 2025, the program stopped covering certain weight loss generics - like phentermine and liraglutide - for TRICARE For Life beneficiaries. That affects over 1.2 million retirees and their spouses. The change came from a 2024 National Defense Authorization Act provision. It’s controversial. Dr. Steve Cohen from the Congressional Budget Office called it a coverage gap, especially since these drugs are FDA-approved and clinically recommended.

Other exclusions include some generic biologics - complex medications like those used for rheumatoid arthritis or psoriasis. These face 22% higher prior authorization rates than regular generics because of strict interchangeability rules. Even if a generic version exists, TRICARE may not approve it unless the prescribing doctor can show the brand-name version failed.

And don’t assume your civilian pharmacy knows TRICARE rules. In the 2025 beneficiary survey, 39% of respondents said pharmacy staff were confused about copays or coverage. One Marine Corps retiree described waiting 45 minutes while the pharmacist called Express Scripts just to confirm a $16 copay was correct.

How to Check If Your Drug Is Covered

The only way to know for sure is to use the TRICARE Formulary Search Tool. Don’t rely on your doctor’s word - even they can get it wrong. Type in the exact drug name and strength. The tool will tell you:

• Is it on the formulary?
• What tier is it?
• Do you need prior authorization?
• What’s the copay at each pharmacy type?

This tool was updated in February 2025 to show real-time cost estimates. It’s mobile-friendly and works even if you’re overseas. If you’re unsure, call the TRICARE Pharmacy Helpline at 1-877-363-1303. They handled 1.2 million calls in 2025 with an average wait time of under five minutes.

How TRICARE Compares to Other Plans

Medicare Part D plans average $7-$10 for generics. VA pharmacies give veterans free drugs. TRICARE’s $13-$16 copays look high at first glance. But here’s the real comparison: TRICARE gives you a zero-dollar option - military pharmacies - that no other federal program offers. If you live near a base, you can save hundreds a year.

Compared to employer plans, TRICARE’s generic coverage is more predictable. Most private insurers change copays every year, add new prior authorization rules, or narrow their formularies. TRICARE’s formulary updates monthly, but the structure stays consistent. And with 94% of beneficiaries reporting no trouble getting Tier 1 generics, access is strong.

The downside? Less flexibility. Commercial insurers cover 98% of prescribed drugs on the first try. TRICARE requires prior authorization for 15-20% of non-formulary generics. That’s not a dealbreaker for most, but it can delay care.

Real Stories From TRICARE Users

On Reddit’s r/MilitaryFinance, a November 2025 thread with 87 comments showed 72% positive experiences. One user wrote: “Got my lisinopril filled at base pharmacy today - saved $48 versus retail.” Another retiree said: “My generic cholesterol med costs $14 for 90 days through home delivery. My civilian friends pay $30 for 30 days.”

But frustrations exist too. A 68-year-old widow wrote: “I can’t get my weight loss pill anymore. I’m not obese, but I have mobility issues. My doctor says it helps. TRICARE says no.” That’s the August 31, 2025 policy in action.

Another common complaint: “I had to make two trips to the clinic because the first prescription was denied. Took three days to get approved.” Prior authorization delays are real - and they add stress to people managing chronic illness.

What’s Changing in 2026

The biggest change is the home delivery copay increase from $13 to $14 on January 1, 2026. That’s the first change since 2023. Retail copays stay at $16. The Defense Health Agency says this won’t hurt adherence - pilot data showed only a 0.8% drop in fills after a similar increase in 2024.

Looking ahead, TRICARE plans to roll out real-time benefit tools by Q3 2026. That means your doctor will see your copay and coverage before they even write the prescription. Step therapy (trying cheaper drugs first) will expand to 15 more drug classes by 2027. And by 2028, pharmacogenomic testing - checking your DNA to predict how you respond to meds - will be integrated for high-risk drugs.

By 2030, TRICARE expects 94% of prescriptions to be generics - up from 92% today. That could save the program $2.3 billion a year as more brand-name drugs lose patent protection.

What You Should Do Now

1. Check your meds - Go to the TRICARE Formulary Search Tool. Type in every drug you take. Note the tier and copay.

2. Use military pharmacies - If you’re within driving distance, this is your best option. Zero copay. Always.

3. Switch to home delivery - For chronic conditions, get 90-day supplies. You’ll save money and avoid running out.

4. Call before you fill - If you’re using a retail pharmacy, call ahead. Ask if they’re a TRICARE network provider and what your copay will be.

5. Ask for prior authorization - If your generic isn’t covered, don’t assume it’s denied. Your doctor can submit a medical necessity request. Approval rates are 78%.

6. Stay updated - The formulary changes monthly. Bookmark the search tool. Set a reminder to check every three months.

TRICARE’s generic drug coverage isn’t perfect. But for millions of service members and their families, it’s reliable, affordable, and smarter than most civilian plans. The key is knowing how to use it - and where to fill your prescriptions.