TRICARE Coverage for Generics: What Military Families Need to Know

When you’re on TRICARE, getting your prescriptions shouldn’t feel like a maze. For millions of military families, TRICARE coverage for generics is the backbone of affordable, reliable medication access. But not all generics are treated the same. Some cost $0. Others cost $16. And a few aren’t covered at all-unless you jump through hoops. Here’s what actually happens when you need a generic drug under TRICARE in 2025.

How TRICARE Handles Generics: The Four Tiers

TRICARE doesn’t just say "yes" or "no" to generics. It organizes them into four clear tiers, and where you fill your prescription changes your out-of-pocket cost dramatically.

• Tier 1: Generic formulary drugs - These are the most common and cheapest. Over 92% of all TRICARE prescriptions are for these. They’re FDA-approved copies of brand-name drugs, same active ingredient, same effect, but 80-85% cheaper.
• Tier 2: Brand-name formulary drugs - Covered, but cost more. Usually only used if no generic exists or if your doctor says you need the brand.
• Tier 3: Non-formulary drugs - These include some generics that aren’t on the approved list. You can still get them, but only after your doctor proves it’s medically necessary. Approval rates are around 78%.
• Tier 4: Non-covered drugs - Not covered at all. No exceptions. This includes certain weight loss generics as of August 31, 2025, affecting over 1.2 million TRICARE For Life beneficiaries.

Knowing your tier is the first step to saving money. But here’s the catch: just because a drug is a generic doesn’t mean it’s automatically in Tier 1. About 12% of generics require prior authorization.

Where You Fill Your Prescription Changes Everything

Your cost for the same generic drug can vary from $0 to $16 depending on where you go. There are three main ways to get your meds:

• Military pharmacies - Best deal. If you’re on TRICARE Prime or TRICARE Select and you’re near a military treatment facility, you can fill your generic prescription with $0 copay. This includes active duty members, retirees, and their families. No paperwork. No waiting. Just walk in and get your lisinopril, metformin, or atorvastatin for free.
• TRICARE Home Delivery - For 90-day supplies, you pay $13 through December 31, 2025. On January 1, 2026, that goes up to $14. This is managed by Express Scripts. It’s convenient for chronic conditions like high blood pressure or diabetes. You get your meds delivered, and it’s often cheaper than retail.
• Network retail pharmacies - CVS, Walgreens, Rite Aid, and others that accept TRICARE. For a 30-day supply of a Tier 1 generic, you pay $16. This rate stays the same through 2026. But here’s the problem: not all pharmacy staff know TRICARE rules. Some try to charge you full price. Always ask if they’re a TRICARE network pharmacy before you pay.

Active duty service members use military pharmacies for 76% of their fills. Retirees? Over 60% use Home Delivery. Why? It’s easier to manage multiple prescriptions, and the 90-day supply cuts down trips.

The TRICARE Formulary Search Tool: Your Secret Weapon

You can’t guess if a drug is covered. You have to check. The official TRICARE Formulary Search tool (on Express Scripts’ site) lets you type in the exact drug name and strength. It tells you:

• Which tier it’s on
• What your copay will be
• Whether prior authorization is needed
• Alternative drugs if it’s not covered

This tool was updated in February 2025 to show real-time costs. But many beneficiaries still don’t use it. They assume their doctor’s prescription is automatically covered. That’s a mistake. One Reddit user wrote: "My provider prescribed a generic not on formulary. Had to wait 72 hours for approval. Cost me an extra clinic trip."

Pro tip: Print or screenshot your search results and bring them to the pharmacy. It cuts down confusion and delays.

What’s Not Covered (And Why)

Not every generic is covered. The biggest change in 2025 was the exclusion of weight loss generics like phentermine and liraglutide for TRICARE For Life beneficiaries. This was mandated by the 2024 National Defense Authorization Act. It affects over 1.2 million older beneficiaries who now pay full price-or nothing at all-if they want these drugs.

Other non-covered drugs include:

• Over-the-counter medications (even if prescribed)
• Drugs used for cosmetic purposes
• Some generic biologics (like biosimilar insulin), which face 22% higher prior authorization rates than regular generics

Why the exclusions? It’s not about safety. It’s about cost. TRICARE saves $1.7 billion a year by pushing generics. But even then, the program draws lines. Weight loss drugs are expensive and controversial in public health policy. So they were removed from coverage.

How TRICARE Compares to Other Plans

TRICARE’s generic copays are higher than Medicare Part D ($7-$10) and way higher than the VA (free). But TRICARE has something they don’t: free access at military pharmacies. That’s huge. If you live near a base, you’re getting premium coverage at zero cost.

Compared to civilian employer plans, TRICARE’s $16 retail copay is actually lower than average. Many private insurers charge $20-$40 for generics. And TRICARE’s 92% generic fill rate is higher than the national average of 90%.

Where TRICARE falls short? Speed. Getting a non-formulary generic approved takes an average of 48 hours. Some require extra lab results or letters from your doctor. That’s frustrating if you’re running out of meds.

Real Stories: What People Are Saying

On Reddit’s r/MilitaryFinance, a November 2025 thread got 87 comments. Seventy-two percent praised TRICARE’s generic coverage. One Marine retiree wrote: "My generic cholesterol med costs $14 for 90 days through Home Delivery. My civilian friends pay $30 for 30 days. I’m saving $100 a month." But not everyone’s happy. Nearly 40% of beneficiaries over 65 are upset about the weight loss drug ban. Others complain about pharmacy staff who don’t know TRICARE rules. One user said: "I was charged $48 at Walgreens because the cashier didn’t know I was TRICARE Prime. Took 20 minutes to fix it." The 2025 TRICARE Beneficiary Survey showed 86% satisfaction with generic access. But 28% of negative reviews cited prior authorization delays. If you’re on a chronic medication, plan ahead.

What’s Changing in 2026

The biggest change? Home Delivery copay goes from $13 to $14 on January 1, 2026. Retail stays at $16. That’s a tiny increase-only $1. Express Scripts predicts it will cut generic fills by just 0.8%. Most people won’t notice.

Other updates coming:

• Real-time benefit tools - By Q3 2026, your doctor’s EHR system will show you your TRICARE copay before they even write the prescription.
• Step therapy expansion - Starting in 2027, you may be required to try one generic before moving to another (like trying metformin before a newer diabetes drug).
• Pharmacogenomic testing - By 2028, TRICARE may test your genes before prescribing certain heart or mental health meds to see how you’ll respond.

These aren’t gimmicks. They’re smart moves to reduce waste and improve outcomes. And they’ll likely make your experience smoother in the long run.

What You Should Do Right Now

If you’re on TRICARE and take generics, here’s your action list:

1. Go to www.esrx.com/tform and search for every drug you take. Save the results.
2. If you’re near a military pharmacy, use it. It’s free. No reason not to.
3. For chronic meds, sign up for Home Delivery. Save money, save trips.
4. Always confirm with the pharmacy that they’re a TRICARE network provider before paying.
5. If your drug isn’t covered, ask your doctor to submit a medical necessity request. 78% get approved.
6. Call the TRICARE Pharmacy Helpline at 1-877-363-1303 if you’re confused. They handled 1.2 million calls in 2025.

TRICARE’s generic drug coverage isn’t perfect. But for a military health program serving 9.5 million people, it’s one of the most efficient systems out there. You just need to know how to use it.

Next Steps: Don’t Guess, Check

The biggest mistake TRICARE users make? Assuming their prescription is covered. It’s not. Always search the formulary. Always confirm with the pharmacy. Always keep a copy of your drug’s coverage status. With a few simple steps, you’ll avoid surprise bills and delays. TRICARE gives you access to some of the most affordable prescription coverage in the country. You just need to know how to use it.