Upcoming Changes for Medication Cost Shares through TRICARE

MOAA makes it a priority to prepare our membership well ahead of changes that will impact their earned benefits. In that regard, please consider this an advance notice for your planning purposes.

The cost shares for your medications, if you do not receive them at a DoD military treatment facility, will increase on Jan. 1. Recall back in the 2017 NDAA, TRICARE’s pharmacy cost shares changed across all medication tiers, and a new fee table was introduced. Beneficiaries saw their prescription fees start to rise in 2018 and 2019. As we published at the time, these fees will accumulate and continue to rise annually until 2027.

According to a large percentage of respondents who have taken MOAA’s health care surveys, many still recall the “sticker shock” they experienced when their mail order generic medication went from $0 to $7 – it was not so bad if you only had to take one, but most people take several so it added up very quickly.

Here are the new FY 2020 fees for all TRICARE pharmacy medication tiers and the year over year annual increases:

These annual average increases continue to be substantial, especially if CPI remains tame and retired pay and social security incomes stay flat.

The bottom line is, TRICARE pharmacy fees and other provider visit cost-shares and premiums for both TRICARE Prime and TRICARE Select, are starting to squeeze beneficiaries. MOAA continues to press the DoD to show the results of how much revenue is being generated from beneficiaries and where it is being directed. We maintain any savings should be re-invested into the TRICARE health program, not diverted into other un-specified accounts.

GI Bill Improvements Pass House

Two legislative proposals that would improve the Post-9/11 GI Bill and set an end date for the Montgomery GI Bill recently passed the House. The Protect the GI Bill Act (H.R.4625), sponsored by Rep. Mike Levin (Calif.), ensures that schools receiving GI Bill funding inform prospective students of the cost of attendance, how much their benefits cover, student outcomes, and more. The bill empowers State Approving Agencies (SAAs) to flag or suspend new enrollments to schools that violate these requirements. The bill also contains several other protections, including a ban on schools misrepresenting themselves while marketing, recruiting and enrolling students.

Further, the GI Bill Planning Act (H.R.4162), sponsored by Rep. Jack Bergman (Mich.), gives new enlistees six months rather than just two weeks, to decide to pay $1200 or opt-out of their Montgomery GI Bill (MGIB) benefit. It also ends with new enlistee enrollments in the outdated MGIB by October 2029. Both bills were approved by voice vote and have been sent to the Senate for further consideration.

The VA Extends Benefits to Blue Water Navy Vietnam Veterans Jan. 1st

The Department of Veterans Affairs begins deciding Blue Water Navy Vietnam Veterans Act of 2019 claims, Jan. 1, 2020. This extends the presumption of herbicide exposure, including toxins such as Agent Orange, for Veterans who served offshore of the Republic of Vietnam during the Vietnam War. This change was required by legislation and a federal court mandate (Procopio v. Wilkie). Prior to these measures, only Vietnam War Veterans who served on the ground or within Vietnam's inland waterways were eligible to receive disability compensation and other benefits based on a presumption of herbicide exposure.

Signed into law June 25, the law specifically affects Blue Water Navy Veterans who served as far as 12 nautical miles offshore of Vietnam between Jan. 6, 1962 and May 7, 1975. The law also applies to Veterans who served in the Korean Demilitarized Zone (DMZ) between Jan. 1, 1967 and Aug. 31, 1971. These Veterans can now apply for disability compensation and other benefits if they have since developed one of 14 conditions that are presumed to be related to exposure to herbicides such as Agent Orange. Veterans no longer need to prove that they were exposed to herbicides. The specific conditions can be found by searching for "Agent Orange" online.

Survivors of Veterans can also file claims for benefits, based on the veteran's service, if the veteran died from at least one of the presumptive conditions associated with Agent Orange. The law also provides benefits for children born with spina bifida, if their parent is or was a veteran with certain verified service in Thailand during a specific period. The Blue Water Navy Act also includes provisions affecting the VA Home Loan Program. The law creates more access for Veterans to obtain no-down-payment home loans, regardless of the loan amount. Also, the home loan funding fee is reduced for eligible Reservists and National Guard first-time borrowers who use their home loan benefit. Certain Purple Heart recipients do not pay any funding fee. The VA's website describes these and other benefits.

Veterans who want to file an initial claim for an herbicide-related disability can use VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits or work with a VA-recognized Veterans Service Organization to assist with the application process. Veterans may also contact their state Veterans Affairs Office.

Blue Water Navy Veterans, who previously filed a claim seeking service connection for one of the 14 presumptive conditions that was denied by VA, may provide or identify any new and relevant information regarding their claim when reapplying. To re-apply, Veterans may use VA Form 20-0995, Decision Review Request: Supplemental Claim. As a result of the new law, the VA will automatically review claims that are currently in the VA review process or under appeal.