Tricare Must Waive Coronavirus Test Visit Copays, But Not Off-Base Pharmacy Fees

Tricare users who typically face copays for off-base doctor visits and tests will not owe anything out of pocket for the appointment if they are receiving a coronavirus test, but those required to head off-base for prescriptions must pay any related costs themselves, Military.com has learned.

The fee waiver is included in coronavirus-related legislation passed last month, known as the Families First Coronavirus Response Act. The law requires that all fees be waived for both the virus test itself and any visit associated with getting the test.

But not just any visit will qualify for a fee waiver, Tricare officials noted in an email to Military.com. To qualify for the waiver, the visit must result in a doctor-ordered COVID-19 test. If no test is ordered, the fee will not be waived.

"The exception to policy will waive the copay for the office visit if a COVID-19 test is ordered as part of the visit," officials said in a statement. "Copays related to doctor office and ER visits that do not elicit a COVID-19 test cannot be waived."

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Just when the waiver will go into effect depends on how quickly system officials can obtain an official authorization required by law as part of the Defense Health Agency's complex management. That authorization must be signed by Defense Secretary Mark Esper, officials said.

Once that is signed, no copay will be required for COVID-19 test-related visits. Users who have paid a copay for a newly covered visit since the measure was signed into law March 18 will be able to file a reimbursement claim, they said.

Individual copay amounts depend upon which Tricare plan the patient is using and count toward a user's annual out-of-pocket cap.

Meanwhile, officials said patients who are newly facing off-base retail pharmacy or mail-order copays for prescription drugs, thanks to limits to on-base pharmacy access during the ongoing pandemic, are not eligible to have those costs waived.

"Prescription drug copay for retail pharmacy or home delivery cannot be waived even if a beneficiary who normally uses a military pharmacy for prescriptions is temporarily diverted to retail or home delivery due to health protection conditions that limit or close military pharmacies," officials said.

-- Amy Bushatz can be reached at amy.bushatz@military.com.

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