Tricare to Raise Pharmacy Copays, Expand Coverage for Cancer, Pain Treatments in 2026

Starting next year, Tricare beneficiaries who obtain prescriptions outside military health facilities will face higher medication costs. However, they will also gain access to new benefits, including coverage for advanced cancer treatments, heart tests, and therapies for chronic pain, as announced by federal officials on Tuesday.

The Defense Department announced in a Federal Register notice that, starting January 1, 2026, most Tricare prescription copayments will increase for medications obtained at retail pharmacies or via mail order.

Generic medications will maintain a price of $16 for 30-day retail prescriptions, while brand-name drugs will increase to $48. Ninety-day mail-order prescriptions cost $14, generic medications cost $4; and brand-name medications cost $44. Medications not on the formulary will cost $85 for a 30-day supply at retail or a 90-day supply through mail order.

Active-duty service members will continue to enjoy free prescriptions filled at military hospitals or clinics, and they will not incur any copays for covered medications at retail pharmacies. The adjustments indicate a rise of 12% to 15.8% from the rates set for 2024. They are part of a comprehensive congressional initiative to incrementally increase patient access to care-sharing within the military health system.

In addition to the increases in copays, Tricare is set to introduce new coverage options in the upcoming year. Among the advancements are radiofrequency ablation for uterine fibroids, cryosurgery for lung and metastatic cancers, coronary calcium testing for heart disease detection, and basivertebral nerve ablation for chronic back pain.

Tricare is set to include coverage for transcutaneous electrical nerve stimulation (TENS) devices aimed at managing post-surgical pain. Additionally, it will support prophylactic surgeries like mastectomies and hysterectomies for patients identified as high risk for specific cancers. Furthermore, individuals who have experienced hearing loss will now be exempt from the requirement to use hearing aids for an extended period before becoming eligible for cochlear implants.

The program will maintain coverage for monoclonal antibody drugs aimed at early Alzheimer’s treatment, contingent upon patients obtaining pre-authorization and undergoing diagnostic testing.

Starting in 2026, Tricare will introduce a new managed care initiative, specifically Tricare Prime Atlanta and Tricare Prime Tampa, aimed at active-duty families, retirees, and their dependents residing in those regions. The initiative, overseen by CareSource Military and Veterans, is set to continue until 2029 and will function in conjunction with current Tricare programs managed by Humana Government Business in the Eastern Region.

“Tricare Prime Atlanta and Tricare Prime Tampa embody a forward-thinking strategy aimed at improving access to care, enriching the patient experience, and pursuing superior health outcomes,” stated Dr. David Krulak, director of the Tricare Health Plan, at the announcement of the pilot earlier this year. “The information gathered from this demonstration will guide future innovations in Tricare across the country.”

The new program and other Tricare plans will be available for enrollment during the upcoming Open Season, which runs from Nov. 10 to Dec. 9, 2025. The open season for the Federal Dental and Vision Insurance Program concludes on December 8.

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