Pharmacy Benefits .—
For: | The cost-sharing amount for a 30-day supply of a retail generic is: | The cost-sharing amount for a 30-day supply of a retail formulary is: | The cost-sharing amount for a 90-day supply of a mail order generic is: | The cost-sharing amount for a 90-day supply of a mail order formulary is: | The cost-sharing amount for a 90-day supply of a mail order non-formulary is: |
|---|---|---|---|---|---|
2018 | $11 | $28 | $7 | $24 | $53 |
2019 | $11 | $28 | $7 | $24 | $53 |
2020 | $13 | $33 | $10 | $29 | $60 |
2021 | $13 | $33 | $10 | $29 | $60 |
2022 | $14 | $38 | $12 | $34 | $68 |
2023 | $14 | $38 | $12 | $34 | $68 |
2024 | $16 | $43 | $13 | $38 | $76 |
2025 | $16 | $43 | $13 | $38 | $76 |
2026 | $16 | $48 | $14 | $44 | $85 |
2027 | $16 | $48 | $14 | $44 | $85 |
Establishment of Committee .—
Advisory Panel .—
Procedures .—
Pharmacy Data Transaction Service .—
Procurement of Pharmaceuticals by TRICARE Retail Pharmacy Program .—
Sharing of Information With State Prescription Drug Monitoring Programs .—
Labeling .—
Definitions .—
Regulations .—
Pub. L. 106–65, div. A, title VII, § 701(a)(1)113 Stat. 677Pub. L. 106–398, § 1 [[div. A]114 Stat. 1654Pub. L. 107–107, div. A, title X, § 1048(c)(4)115 Stat. 1226Pub. L. 108–136, div. A, title VII, § 725117 Stat. 1535Pub. L. 108–375, div. A, title VII, § 714118 Stat. 1985Pub. L. 110–181, div. A, title VII, § 703(a)122 Stat. 188Pub. L. 111–84, div. A, title X, § 1073(a)(10)123 Stat. 2473Pub. L. 112–239, div. A, title VII126 Stat. 1798Pub. L. 113–291, div. A, title VII, § 702(a)128 Stat. 3410Pub. L. 114–92, div. A, title VII129 Stat. 860Pub. L. 115–91, div. A, title VII131 Stat. 1433Pub. L. 115–232, div. A, title VII, § 715(a)132 Stat. 1813Pub. L. 116–92, div. A, title VII, § 713(a)133 Stat. 1446Pub. L. 118–159, div. A, title VII138 Stat. 1942(Added , , ; amended , title X, § 1087(a)(5)], , , 1654A–290; , , ; , , ; , , ; , , ; , , ; , §§ 702, 712(a), , , 1802; –(c)(1), , ; , §§ 702, 715(f), , , 867; , §§ 702(a), (b)(1), 714, title X, § 1081(a)(24), , , 1434, 1438, 1595; , , ; , (b), , ; , §§ 702, 707(a), , , 1944.)
Editorial Notes
References in Text
section 715 of Pub. L. 114–92Section 715 of the National Defense Authorization Act for Fiscal Year 2016, referred to in subsec. (a)(2)(A), is , which is set out as a note under this section.
Pub. L. 104–191110 Stat. 1936section 201 of Title 42The Health Insurance Portability and Accountability Act of 1996, referred to in subsec. (g)(3)(C), is , , . For complete classification of this Act to the Code, see Short Title of 1996 Amendments note set out under , The Public Health and Welfare, and Tables.
act June 25, 1938, ch. 67552 Stat. 1040section 301 of Title 21The Federal Food, Drug, and Cosmetic Act, referred to in subsec. (h), is , , which is classified generally to chapter 9 (§ 301 et seq.) of Title 21, Food and Drugs. For complete classification of this Act to the Code, see and Tables.
Amendments
Pub. L. 118–159, § 7022024—Subsec. (a)(6)(D). , added subpar. (D).
Pub. L. 118–159, § 707(a)Subsec. (a)(6)(E). , added subpar. (E).
Pub. L. 116–92, § 713(b)2019—Subsec. (b)(1). , substituted “under subsection (j)” for “under subsection (h)”.
Pub. L. 116–92, § 713(a)Subsecs. (h) to (j). , added subsec. (h) and redesignated former subsecs. (h) and (i) as (i) and (j), respectively.
Pub. L. 115–2322018—Subsecs. (g) to (i). added subsec. (g) and redesignated former subsecs. (g) and (h) as (h) and (i), respectively.
Pub. L. 115–91, § 702(a)2017—Subsec. (a)(6). , amended par. (6) generally, substituting provisions relating to cost-sharing amounts for the years 2018 through 2027 and for any year after 2027 for provisions relating to cost-sharing amounts, limitation on requirements for medicare-eligible beneficiaries, and increases beginning on .
Pub. L. 115–91, § 1081(a)(24)Subsec. (a)(9)(B), (C). , realigned margins.
Pub. L. 115–91, § 702(b)(1)Subsec. (a)(10). , added par. (10).
Pub. L. 115–91, § 714Subsec. (d)(3). , added par. (3).
Pub. L. 114–92, § 715(f)2015—Subsec. (a)(2)(A). , inserted at end “With respect to members of the uniformed services, such uniform formulary shall include pharmaceutical agents on the joint uniform formulary established under section 715 of the National Defense Authorization Act for Fiscal Year 2016.”
Pub. L. 114–92, § 702(a)(1)(A)Subsec. (a)(6)(A)(i)(I). , substituted “$10” for “$8”.
Pub. L. 114–92, § 702(a)(1)(B)Subsec. (a)(6)(A)(i)(II). , substituted “$24” for “$20”.
Pub. L. 114–92, § 702(a)(2)(A)Subsec. (a)(6)(A)(ii)(II). , substituted “$20” for “$16”.
Pub. L. 114–92, § 702(a)(2)(B)Subsec. (a)(6)(A)(ii)(III). , substituted “$49” for “$46”.
Pub. L. 114–92, § 702(b)(1)Subsec. (a)(6)(C)(i). , substituted “Beginning ,” for “Beginning ,”.
Pub. L. 114–92, § 702(b)(2)Subsec. (a)(6)(C)(ii). , added cl. (ii) and struck out former cl. (ii) which read as follows: “If the amount of the increase otherwise provided for a year by clause (i) is less than $1, the increase shall not be made for such year, but shall be carried over to, and accumulated with, the amount of the increase for the subsequent year or years and made when the aggregate amount of increases carried over under this clause for a year is $1 or more.”
Pub. L. 113–291, § 702(a)2014—Subsec. (a)(5). , substituted “the national mail-order pharmacy program” for “at least one of the means described in paragraph (2)(E)” and “shall include cost-sharing by the eligible covered beneficiary as specified in paragraph (6).” for “may include cost sharing by the eligible covered beneficiary in addition to any such cost sharing applicable to agents on the uniform formulary.”
Pub. L. 113–291, § 702(b)(1)(A)Subsec. (a)(6)(A)(i)(I). , substituted “$8” for “$5”.
Pub. L. 113–291, § 702(b)(1)(B)Subsec. (a)(6)(A)(i)(II). , substituted “$20.” for “$17; and”.
Pub. L. 113–291, § 702(b)(1)(C)Subsec. (a)(6)(A)(i)(III). , struck out subcl. (III) which read as follows: “in the case of nonformulary agents, $44.”
Pub. L. 113–291, § 702(b)(2)(A)Subsec. (a)(6)(A)(ii)(II). , substituted “$16” for “$13”.
Pub. L. 113–291, § 702(b)(2)(B)Subsec. (a)(6)(A)(ii)(III). , substituted “$46” for “$43”.
Pub. L. 113–291, § 702(c)(1)Subsec. (a)(9). , which directed amendment of such section by adding par. (9) at the end, was executed by adding par. (9) at the end of subsec. (a), to reflect the probable intent of Congress.
Pub. L. 112–239, § 702(a)(1)2013—Subsec. (a)(2)(D). , (c)(2)(A), substituted “Except as provided in subparagraph (F), no pharmaceutical agent may be excluded” for “No pharmaceutical agent may be excluded” and struck out at end “The Secretary shall begin to implement the uniform formulary not later than .”.
Pub. L. 112–239, § 702(a)(2)Subsec. (a)(2)(F). , added subpar. (F).
Pub. L. 112–239, § 712(a)(1)section 1079 of this titlesection 1086 of this titleSubsec. (a)(6)(A). , added subpar. (A) and struck out former subpar. (A) which read as follows: “The Secretary, in the regulations prescribed under subsection (g), may establish cost sharing requirements (which may be established as a percentage or fixed dollar amount) under the pharmacy benefits program for generic, formulary, and nonformulary agents. For nonformulary agents, cost sharing shall be consistent with common industry practice and not in excess of amounts generally comparable to 20 percent for beneficiaries covered by or 25 percent for beneficiaries covered by .”
Pub. L. 112–239, § 712(a)(2)Subsec. (a)(6)(C). , added subpar. (C).
Pub. L. 112–239, § 702(c)(1)Subsec. (b)(1). , substituted “subsection (h)” for “subsection (g)”.
Pub. L. 112–239, § 702(c)(2)(B)Subsec. (b)(2). , substituted “The committee” for “Not later than 90 days after the establishment of the Pharmacy and Therapeutics Committee by the Secretary, the committee shall convene to design a proposed uniform formulary for submission to the Secretary. After such 90-day period, the committee”.
Pub. L. 112–239, § 702(c)(2)(C)Subsec. (d)(2). , substituted “The Secretary” for “Effective not later than , the Secretary” and “the managed care support contracts current as of ,” for “the current managed care support contracts”.
Pub. L. 112–239, § 702(b)Subsec. (g)(3), (4). , added pars. (3) and (4).
Pub. L. 111–842009—Subsec. (f). substituted “after ” for “on or after the date of the enactment of the National Defense Authorization Act for Fiscal Year 2008”.
Pub. L. 110–1812008—Subsecs. (f) to (h). added subsec. (f) and redesignated former subsecs. (f) and (g) as (g) and (h), respectively.
Pub. L. 108–375, § 714(b)2004—Subsec. (a)(2)(E)(i). , inserted before semicolon at end “and additional determinations by the Pharmacy and Therapeutics Committee of the relative clinical and cost effectiveness of the agents”.
Pub. L. 108–375, § 714(a)Subsec. (a)(6). , designated existing provisions as subpar. (A) and added subpar. (B).
Pub. L. 108–136, § 725(1)2003—Subsec. (b)(1). , substituted “facilities and representatives of providers in facilities of the uniformed services” for “facilities, contractors responsible for the TRICARE retail pharmacy program, contractors responsible for the national mail-order pharmacy program, providers in facilities of the uniformed services, and TRICARE network providers” in second sentence.
Pub. L. 108–136, § 725(2)Subsec. (c)(2). , substituted “represent—” for “represent nongovernmental”, inserted “(A) nongovernmental” before “organizations”, substituted “beneficiaries;” for “beneficiaries.”, and added subpars. (B) to (D).
Pub. L. 107–1072001—Subsec. (a)(8). substituted “,” for “the date of the enactment of this section”.
Pub. L. 106–398, § 1 [[div. A]2000—Subsec. (a)(6). , title X, § 1087(a)(5)(A)], substituted “in the regulations prescribed” for “as part of the regulations established”.
Pub. L. 106–398, § 1 [[div. A]Subsec. (a)(7). , title X, § 1087(a)(5)(B)], substituted “that are not included on the uniform formulary but that are” for “not included on the uniform formulary, but,”.
Pub. L. 106–398, § 1 [[div. A]Subsec. (b)(1). , title X, § 1087(a)(5)(C)], substituted “prescribed under” for “required by” in last sentence.
Pub. L. 106–398, § 1 [[div. A]Subsec. (d)(2). , title X, § 1087(a)(5)(D)], substituted “Effective not later than , the Secretary shall use” for “Not later than 6 months after the date of the enactment of this section, the Secretary shall utilize”.
Pub. L. 106–398, § 1 [[div. A]Subsec. (e). , title X, § 1087(a)(5)(E)], substituted “The” for “Not later than , the” and inserted “in” before “the TRICARE” and before “the national”.
Pub. L. 106–398, § 1 [[div. A]Subsec. (f). , title X, § 1087(a)(5)(F)], substituted “In this section:” for “As used in this section—” in introductory provisions, “The term” for “the term” in pars. (1) and (2), and a period for “; and” at end of par. (1).
Pub. L. 106–398, § 1 [[div. A]Subsec. (g). , title X, § 1087(a)(5)(G)], substituted “prescribe” for “promulgate”.
Statutory Notes and Related Subsidiaries
Effective Date of 2013 Amendment
Pub. L. 112–239, div. A, title VII, § 712(b)126 Stat. 1802
In general .—
Federal register .—
Regulations
Pub. L. 115–91, div. A, title VII, § 702(b)(3)131 Stat. 1434
Pub. L. 110–181, div. A, title VII, § 703(b)122 Stat. 188Pub. L. 110–417122 Stat. 4613Pub. L. 111–84, div. A, title X, § 1073(c)(12)123 Stat. 2475
Pub. L. 111–84, div. A, title X, § 1073(c)123 Stat. 2474section 1061(b)(3) of Pub. L. 110–417Pub. L. 110–417[, , , provided that the amendment made by section 1073(c)(12) to , included in the credit set out above, is effective as of , and as if included in as enacted.]
Termination of Advisory Panels
Advisory panels established after , to terminate not later than the expiration of the 2-year period beginning on the date of their establishment, unless, in the case of a panel established by the President or an officer of the Federal Government, such panel is renewed by appropriate action prior to the expiration of such 2-year period, or in the case of a panel established by Congress, its duration is otherwise provided for by law. See sections 1001(2) and 1013 of Title 5, Government Organization and Employees.
Pilot Program on Receipt of Non-Generic Prescription Maintenance Medications Under TRICARE Pharmacy Benefits Program
Pub. L. 116–283, div. A, title VII, § 706134 Stat. 3689Pub. L. 117–81, div. A, title VII, § 706135 Stat. 1781
Pilot Program.—
Authority .—
Requirement .—
Duration .—
Selection of Medication .—
Notification .—
Reimbursement .—
Briefing and Reports.—
Briefing .—
Interim report .—
Comptroller general report.—
In general .—
Elements .—
Rule of Construction .—
Definitions .—
Policy To Address Prescription Opioid Safety
Pub. L. 116–283, div. A, title VII, § 719134 Stat. 3696
Requirement .—
Elements .—
Implementation
Pub. L. 116–92, div. A, title VII, § 713(c)133 Stat. 1446
Reimbursement by Department of Defense to Entities Carrying Out State Vaccination Programs for Costs of Vaccines Provided to Covered Beneficiaries
Pub. L. 114–328, div. A, title VII, § 719130 Stat. 2226Pub. L. 115–91, div. A, title VII, § 718131 Stat. 1440
Reimbursement.—
In general .—
Amount of reimbursement.—
In general .—
Limitation .—
Definitions .—
Covered beneficiary; tricare program .—
State vaccination program .—
Pilot Program for Prescription Drug Acquisition Cost Parity in the TRICARE Pharmacy Benefits Program
Pub. L. 114–328, div. A, title VII, § 743130 Stat. 2238
Authority to Establish Pilot Program .—
Elements of Pilot Program .—
Consultation .—
Duration of Pilot Program .—
Reports .—
Joint Uniform Formulary for Transition of Care
Pub. L. 114–92, div. A, title VII, § 715129 Stat. 866
Joint Formulary .—
Selection .—
Report .—
Construction .—
Definitions .—
Conforming Amendment .—
[Amended this section.]”
Pilot Program on Medication Therapy Management Under TRICARE Program
Pub. L. 113–291, div. A, title VII, § 726128 Stat. 3419
Establishment .—
Elements of Pilot Program .—
Locations.—
Selection .—
First location criteria .—
Second location criteria .—
Third location criterion .—
Duration .—
Report .—
Definitions .—
Pilot Program for Refills of Maintenance Medications for TRICARE for Life Beneficiaries Through the TRICARE Mail-Order Pharmacy Program
Pub. L. 112–239, div. A, title VII, § 716126 Stat. 1804Pub. L. 113–291, div. A, title VII, § 702(c)(2)128 Stat. 3411Pub. L. 115–91, div. A, title X, § 1051(r)(2)131 Stat. 1565
In General .—
Medications Covered.—
Determination .—
Supply .—
Exemption .—
Nonparticipation.—
Opt out .—
Waiver .—
Regulations .—
Sunset .—
TRICARE for Life Beneficiary Defined .—
Education and Training on Use of Pharmaceuticals in Rehabilitation Programs for Wounded Warriors
Pub. L. 111–383, div. A, title VII, § 716124 Stat. 4250
Education and Training Required .—
Recipients of Training .—
Elements of Training .—
Tailoring of Training .—
Review of Pharmacy.—
Review .—
Recommendations .—
Demonstration Project on Coverage of Selected Over-the-Counter Drugs Under the Pharmacy Benefits Program
Pub. L. 109–364, div. A, title VII, § 705120 Stat. 2280Pub. L. 111–383, div. A, title X, § 1075(g)(5)124 Stat. 4377
Requirement to Conduct Demonstration .—
Elements of Demonstration Project.—
Inclusion of certain over-the-counter drugs .—
Conduct through military facilities, retail pharmacies, or mail order program .—
Period of demonstration .—
Implementation deadline .—
Evaluation of Demonstration Project .—
Report .—
Continuation of Demonstration Project .—
Definitions .—
Interoperability of Department of Veterans Affairs and Department of Defense Pharmacy Data Systems
Pub. L. 107–314, div. A, title VII, § 724116 Stat. 2598
Interoperability .—
Alternative Requirement .—
Implementation Funding for Alternative Requirement .—
Deadline for Establishment of Committee
Pub. L. 106–65, div. A, title VII, § 701(b)113 Stat. 680, , , directed the Secretary of Defense to establish the Pharmacy and Therapeutics Committee required by subsec. (b) of this section not later than 30 days after .
Reports Required
Pub. L. 106–65, div. A, title VII, § 701(c)113 Stat. 680, , , directed the Secretary of Defense to submit reports to Congress, not later than Apr. 1 and Oct. 1 of fiscal years 2000 and 2001, on the implementation of the uniform formulary required under subsec. (a) of this section, the results of a survey conducted by the Secretary of prescribers for military medical treatment facilities and TRICARE contractors, the operation of the Pharmacy Data Transaction Service required by subsec. (e) of this section, and any other actions taken by the Secretary to improve management of the pharmacy benefits program under this section.
Study for Design of Pharmacy Benefit for Certain Covered Beneficiaries
Pub. L. 106–65, div. A, title VII, § 701(d)113 Stat. 680Pub. L. 107–107, div. A, title VII, § 723115 Stat. 1168, , , required the Secretary of Defense to prepare and submit to Congress, by , a study on a design for a comprehensive pharmacy benefit for covered beneficiaries under chapter 55 of title 10, who are entitled to benefits under part A, and enrolled under part B, of title XVIII of the Social Security Act, and to provide an estimate of the costs of implementing and operating such design, prior to repeal by , , .