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 most military families, generic drugs are the go-to choice-cheaper, just as effective, and covered under the program. But knowing TRICARE coverage for generics isn’t as simple as just saying "it’s generic." There are tiers, copays, formularies, and rules that change depending on where you fill your prescription and who you are.

How TRICARE Covers Generic Drugs

TRICARE doesn’t cover every generic drug just because it’s generic. It has a list-called the formulary-that tells you exactly which ones are covered. As of October 2025, TRICARE includes about 5,500 brand-name and generic medications on this list, with generics making up 92% of all prescriptions filled. That’s higher than most civilian insurance plans.

The key thing to understand: not every generic is automatically approved. Some generics are on the formulary, some aren’t. And even if a generic is on the list, you still have to pay something-unless you’re active duty.

The Four Tiers of TRICARE Drug Coverage

TRICARE organizes drugs into four tiers. For generics, it’s mostly Tier 1, but here’s how it all breaks down:

• Tier 1: Generic formulary drugs - These are the cheapest, most preferred options. Most common medications like lisinopril, metformin, or atorvastatin fall here.
• Tier 2: Brand-name formulary drugs - These are covered, but cost more. You’ll pay higher copays unless there’s no generic available.
• Tier 3: Non-formulary drugs - These aren’t on the approved list. You can still get them, but you need a medical necessity approval. About 15-20% of generic requests fall here.
• Tier 4: Non-covered drugs - These aren’t covered at all. Examples include weight loss medications like semaglutide (Ozempic) and liraglutide (Saxenda), which were removed from coverage for TRICARE For Life beneficiaries as of August 31, 2025.

Where You Fill Your Prescription Changes the Cost

One of the biggest advantages of TRICARE is how much you save depending on where you get your meds. Here’s what you pay in 2025 for a Tier 1 generic:

Active duty service members pay nothing at any pharmacy. Retirees and family members pay the rates above. The big savings come from military pharmacies-if you live near one, use it. A 90-day supply of a generic cholesterol drug through home delivery costs $13. At a civilian pharmacy, you’d pay $30 or more.

How to Check If Your Generic Is Covered

You can’t assume a drug is covered just because it’s generic. The TRICARE Formulary Search tool (available at esrx.com/tform) is your best friend. Just type in the drug name and strength. It will tell you:

• Which tier it’s on
• What your copay will be
• Whether prior authorization is needed

Many users report confusion when their doctor prescribes a generic that’s not on the formulary. That’s because there are thousands of generic versions of the same drug-only some are approved by TRICARE. If your drug isn’t listed, you’ll need to request a medical necessity exception. About 78% of those requests get approved, but it can take up to 72 hours. That means you might have to delay your refill or make an extra trip to the clinic.

What’s Not Covered-and Why

Not all generics are treated equally. As of August 31, 2025, TRICARE stopped covering weight loss drugs like semaglutide and liraglutide for TRICARE For Life beneficiaries (mostly retirees over 65). This was a policy change tied to the 2024 National Defense Authorization Act. About 1.2 million people were affected.

Some other generics may be excluded because:

• They’re newer and haven’t been reviewed yet
• There’s a cheaper, equally effective alternative already on the formulary
• They’re considered non-essential (like some cosmetic or non-life-saving medications)

Biologic generics (like those for rheumatoid arthritis or Crohn’s disease) face even stricter rules. They require 22% more prior authorizations than regular generics because of complex FDA interchangeability rules.

How TRICARE Compares to Other Plans

TRICARE isn’t the cheapest for generics-but it’s not the worst. Medicare Part D averages $7-$10 for generics. TRICARE’s $13-$16 copays seem high, but here’s the catch: Medicare doesn’t have free military pharmacies. If you’re a retiree, TRICARE’s $0 copay at base pharmacies gives you a real edge.

Compared to the VA, TRICARE requires copays for most people. VA gives free meds to eligible veterans. But TRICARE covers more people-nearly 9.5 million-and offers broader access through retail and home delivery.

Most civilian employer plans have higher copays than TRICARE’s retail rate, but they often have wider formularies. TRICARE’s formulary is tighter. If your doctor prescribes something off-list, you’re stuck waiting for approval.

Real Stories from TRICARE Users

On Reddit, a Marine Corps retiree wrote: "My generic cholesterol pill costs $14 for 90 days through home delivery. My civilian friends pay $30 for 30 days. That’s a 70% savings." That’s the kind of win TRICARE delivers.

But others aren’t happy. A 68-year-old retiree on a forum said: "I’ve been on Ozempic for diabetes and weight loss. Now I’m paying $1,200 a month out of pocket. TRICARE dropped it, and Medicare won’t cover it either. I’m stuck."

Another common complaint: pharmacists at retail pharmacies don’t always know TRICARE rules. One user reported being charged $48 for a generic because the cashier didn’t know TRICARE had a network agreement. Always double-check your receipt. If you’re overcharged, call the TRICARE Pharmacy Helpline at 1-877-363-1303.

What’s Changing in 2026

On January 1, 2026, TRICARE’s home delivery copay for generics will go from $13 to $14. Retail stays at $16. Military pharmacies remain $0.

TRICARE is also rolling out new tools:

• Real-time benefit checks by Q3 2026-your doctor will see your copay and coverage before they write the script.
• Step therapy expansion to 15 more drug classes by 2027-you might need to try a cheaper generic first before getting a more expensive one.
• Pharmacogenomic testing by 2028-some high-risk meds will require genetic testing to ensure they’re safe for you.

These changes aim to cut waste and improve safety. But they also mean more paperwork and delays for some users.

How to Use TRICARE Generics the Smart Way

Here’s how to avoid headaches:

1. Always check the TRICARE Formulary Search tool before your doctor writes a script.
2. Use military pharmacies whenever possible-$0 is $0.
3. For chronic conditions (like high blood pressure or diabetes), sign up for TRICARE Home Delivery. It’s cheaper and you get 90-day supplies.
4. If your generic isn’t covered, ask your doctor to request a medical necessity exception. Have your medical records ready.
5. Keep a list of your medications and their formulary status. Update it every time you get a new prescription.

Most people using TRICARE for generics report high satisfaction-86% in the 2025 beneficiary survey. The biggest complaints come from those who need non-formulary drugs or were hit by the weight loss medication cutoff.

Final Takeaway

TRICARE coverage for generics is one of the program’s strongest features. It saves beneficiaries billions every year and keeps medications accessible. But it’s not perfect. You need to be proactive. Know your tier. Know your pharmacy. Know your formulary. And if something doesn’t look right, call TRICARE. Don’t assume. Don’t wait. A $14 copay today can turn into a $1,200 bill tomorrow if you don’t check.