Tricare to Raise Pharmacy Copays in 2026 While Expanding Coverage for Cancer, Heart Disease, and Pain Treatments

Starting Jan. 1, 2026, military beneficiaries will face higher retail and mail-order prescription costs but gain access to expanded benefits — including new cancer therapies, heart screening procedures, and chronic pain relief technologies.

WASHINGTON | Military service members, retirees, and their families will see higher out-of-pocket pharmacy costs in 2026 under Tricare’s latest update — but they’ll also gain access to expanded medical coverage for cancer, cardiac, and chronic pain treatments, according to a notice published Tuesday in the Federal Register.

The Department of Defense’s Tricare Pharmacy Program will raise copayments for prescriptions filled outside military treatment facilities beginning Jan. 1, 2026, while continuing to provide free prescriptions at on-base hospitals and clinics.

Under the new schedule, 30-day retail prescriptions will remain at $16 for generic medications but will climb to $48 for brand-name drugs. Mail-order prescriptions will cost $14 for generics and $44 for branded medications, while non-formulary drugs will rise to $85 for both retail and mail-order fills.

This marks a 12% to 15.8% increase compared to current copay levels set in early 2024 — part of a broader Congress-approved initiative (2018) requiring patients to gradually shoulder a higher portion of Tricare’s costs.

“The goal is to modernize cost-sharing while improving access to evidence-based treatments for chronic and life-threatening conditions,” a Defense Health Agency (DHA) spokesperson said Tuesday.

Expanded Medical Benefits in 2026

Tricare’s 2026 update does more than raise prices — it broadens coverage to include innovative medical procedures and preventive surgeries once unavailable to military beneficiaries. Among the newly covered treatments:

• Radiofrequency ablation for uterine fibroids
• Cryosurgery for lung cancer and other metastatic tumors
• Coronary calcium tests for heart-disease risk detection
• Basivertebral nerve ablation for chronic lower back pain

Additionally, Tricare will now cover transcutaneous electrical nerve stimulation (TENS) devices for post-operative pain management — a key advancement in reducing opioid reliance among recovering patients.

Beneficiaries identified as genetically predisposed to certain cancers will also be eligible for preventive mastectomies and hysterectomies, marking a major step toward proactive oncology care in the military health system.

Audiology and Alzheimer’s Updates

In a move welcomed by advocacy groups, Tricare will remove the hearing-aid trial requirement for dependents with severe hearing loss, streamlining eligibility for cochlear implants.

The program will also continue to cover monoclonal antibody therapies for early-stage Alzheimer’s disease, introduced in 2024, with continued requirements for pre-authorization and diagnostic testing to confirm eligibility.

Regional Expansion: Tampa and Atlanta

In 2026, Tricare will also launch a new Prime option in Tampa, Florida, and Atlanta, Georgia, managed by CareSource Military and Veterans. This pilot aims to test expanded managed-care accessibility and improved service integration for retirees and active-duty families in high-density regions.

Defense officials say these changes reflect Tricare’s ongoing transformation from a traditional cost-coverage program into a comprehensive health management network, balancing fiscal discipline with medical innovation.

Strategic Outlook

For the Pentagon, the changes align with a broader shift in Defense Health Agency policy — integrating modern treatment options while controlling spending through incremental cost adjustments. Analysts note that the increase in prescription copays may draw criticism from veteran groups, but the simultaneous addition of new cancer and pain-management therapies could offset concerns by showcasing tangible care improvements.

“We’re seeing Tricare evolve toward value-based care — prioritizing long-term health outcomes rather than short-term savings,” said defense health analyst Karen Wiley of the Center for Military Medicine.

Bottom Line

Tricare’s 2026 overhaul presents a mixed bag for its 9.6 million beneficiaries: higher drug costs, but broader, more advanced medical coverage. With chronic pain, cancer prevention, and cognitive health at the forefront, the update signals a Defense Department intent on modernizing the military health system for the next decade — even if it means asking patients to pay a little more for it.

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-- By Letitia Jacobs

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