TRICARE Generic vs Brand-Name Drug Costs & Rules (2026)
*Note: TRICARE.com is an independent reference site and is not affiliated with the Department of Defense. Visit TRICARE.mil for official policy and current regulations.*
## Quick answer TRICARE requires the use of generic drugs whenever they are available and clinically appropriate. If you choose a brand-name drug when a generic equivalent exists, you will typically pay the full cost of the brand-name drug minus the cost of the generic, unless your provider proves medical necessity.
Details
### The "Generic First" Requirement TRICARE follows a mandatory generic drug policy. Under the pharmacy benefit managed by **Express Scripts**, if the FDA has approved a generic version of a medication, TRICARE will only cover the generic version.
If you or your provider insist on the brand-name version despite a generic being available, you will be responsible for the generic copay **plus** the entire price difference between the generic and the brand-name drug.
### 2026 Pharmacy Copay Structure Pharmacy costs depend on whether the drug is on the TRICARE Formulary and where you fill the prescription. For 2026, most beneficiaries (excluding Active Duty Service Members, who pay $0) face the following costs:
* **Military Pharmacy (Base):** $0 for both generic and brand-name (if stocked). * **TRICARE Pharmacy Home Delivery:** * **Generic:** $13 (90-day supply) * **Brand-name (Formulary):** $38 (90-day supply) * **Non-formulary:** $76 (90-day supply) * **Retail Network Pharmacy:** * **Generic:** $16 (30-day supply) * **Brand-name (Formulary):** $43 (30-day supply) * **Non-formulary:** $76 or not covered (30-day supply)
### Seeking a "Medical Necessity" Waiver If your doctor believes the brand-name drug is medically necessary (e.g., you have a documented allergy to an inactive ingredient in the generic), they can submit a **Medical Necessity (MN)** form to Express Scripts. * If approved, you can get the brand-name drug at the generic copay price ($13 via mail-order). * If denied, you may still purchase the brand-name drug, but you will pay the much higher non-formulary or "cost difference" price.
### Maintenance Medications For brand-name maintenance medications (drugs taken regularly for chronic conditions), you are generally required to use **Home Delivery** or a **Military Pharmacy**. If you fill these at a retail pharmacy more than twice, TRICARE may stop covering the cost entirely, forcing you to pay 100% out of pocket.
## Who this affects * **Active Duty Family Members (ADFMs):** Subject to generic mandates and standard copays. * **Retirees and their Families:** Subject to generic mandates and standard copays. * **TRICARE Reserve Select / Retired Reserve:** Same pharmacy rules apply regardless of premium-based plan status. * **Active Duty Service Members (ADSMs):** Always $0 copay, but must still use generics unless a waiver is granted for clinical reasons.
## Sources * **TRICARE.mil Pharmacy Weights & Costs:** [https://www.tricare.mil/Costs/PharmacyCosts](https://www.tricare.mil/Costs/PharmacyCosts) * **Express Scripts TRICARE Formulary Search:** [https://www.express-scripts.com/frontend/open-enrollment-tricare/#/](https://www.express-scripts.com/frontend/open-enrollment-tricare/#/) * **Defense Health Agency (DHA) Pharmacy Program:** [https://health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/Pharmacy-Operations](https://health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/Pharmacy-Operations)