Notice2025-19672
TRICARE; Notice of TRICARE Plan Program Changes for Calendar Year (CY) 2026
Primary source
Metadata and text below are from the Federal Register, a public-domain U.S. government work. Always verify the official published version before relying on it for any legal matter.
Published
October 28, 2025
Issuing agencies
Defense Department
Abstract
This notice provides information regarding TRICARE plan program changes for CY 2026.
Full Text
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<title>Federal Register, Volume 90 Issue 206 (Tuesday, October 28, 2025)</title>
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[Federal Register Volume 90, Number 206 (Tuesday, October 28, 2025)]
[Notices]
[Pages 48728-48731]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2025-19672]
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DEPARTMENT OF DEFENSE
Office of the Secretary
TRICARE; Notice of TRICARE Plan Program Changes for Calendar Year
(CY) 2026
AGENCY: Office of the Secretary of Defense, Department of Defense
(DoD).
ACTION: TRICARE plan program changes for CY 2026.
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SUMMARY: This notice provides information regarding TRICARE plan
program changes for CY 2026.
DATES: TRICARE Health Plan information in this notice is valid for
services during CY 2026 (January 1-December 31, 2026).
ADDRESSES: Defense Health Agency, TRICARE Health Plan Division, 7700
Arlington Boulevard, Suite 5101, Falls Church, Virginia 22042-5101.
FOR FURTHER INFORMATION CONTACT: Ms. Debra Fisher, 703-275-6224,
<a href="/cdn-cgi/l/email-protection#2f4b474e01414c5d01474a4e435b474c4e5d4a02405f5c01424d57015b475f025f4043464c56024e414b025f5d40485d4e425c024d5d4e414c476f474a4e435b4701424643">dha.ncr.healthcare-ops.mbx.thp-policy-and-programs-branch@health.mil</a>.
SUPPLEMENTARY INFORMATION: A final rule published in the Federal
Register (FR) on February 15, 2019 (84 FR 4326-4333) established the
requirement for the Director, Defense Health Agency (DHA), to provide
notice of TRICARE program changes to Military Health System (MHS)
beneficiaries each CY in connection with the annual open season
enrollment period. The following changes or improvements to the TRICARE
program benefits apply for CY 2026.
Open Season Announcement
Open Season is an annual period when beneficiaries may enroll in a
health plan or make changes to their healthcare, dental, and/or vision
coverage for the next CY.
During the TRICARE Open Season running from November 10 through
December 9, 2025, qualified MHS beneficiaries may enroll in or change
their TRICARE Prime or TRICARE Select plan.
During the Federal Employee Dental and Vision Insurance Program
(FEDVIP) Open Season, running from November 10 through December 8,
2025, qualified MHS beneficiaries, including TRICARE for Life
beneficiaries, may enroll in or make changes to their dental and/or
vision plans. FEDVIP is operated by the U.S. Office of Personnel
Management.
Any changes MHS beneficiaries make during Open Season will take
effect on January 1, 2026. If a beneficiary remains eligible and does
not make any changes during Open Season, then their coverage will
remain the same for 2026. TRICARE enrollees can ensure they receive
important health plan information by promptly listing any change in
mailing address, email address, and other information in the Defense
Enrollment Eligibility Reporting System (DEERS) and verifying their
preference for receipt of information digitally or by paper mailings
with their respective regional contractors. TRICARE enrollees can avoid
any health care coverage gaps by ensuring changes in their payment
[[Page 48729]]
information is also updated with their regional contractors. See the
Qualifying Life Events (<a href="https://health.mil/Military-Health-Topics/MHS-Toolkits/Toolkits/QLEhttps://health.mil/Military-Health-Topics/MHS-Toolkits/Toolkits/QLE">https://health.mil/Military-Health-Topics/MHS-Toolkits/Toolkits/QLEhttps://health.mil/Military-Health-Topics/MHS-Toolkits/Toolkits/QLE</a>) guide for when to update information in DEERS
throughout the year.
Annual Announcements
The following TRICARE program features are subject to a year-to-
year determination and are announced each year prior to the annual
TRICARE Open Season.
Urgent Care Visits: The number of urgent care visits remains
unlimited without referrals for TRICARE Prime enrollees for Plan CY
2026. Beneficiaries may receive urgent care from TRICARE-authorized
urgent care centers (UCCs) and convenience clinics (CCs), either
network or non-network, without a referral. They may also receive
urgent care from any TRICARE network provider (i.e., family medicine;
internal medicine-general practice; pediatricians). In situations when
a TRICARE Prime enrollee seeks care from a non-network TRICARE
authorized provider (outside of a TRICARE-authorized UCC or CC), the
usual TRICARE Prime Point of Service (POS) deductible and cost-shares
will apply. Private Sector care for active duty Service members is
subject to different rules. Covered beneficiaries in the U.S. who want
assistance with decisions whether to seek urgent care, except those
enrolled in the Uniformed Services Family Health Plan (USFHP) or in a
plan under the Competitive Plans Demonstration (CPD), may call the MHS
Nurse Advice Line (NAL) at 1-800-874-2273 for health care guidance from
a specially trained registered nurse. The NAL is available 24/7 to
eligible TRICARE beneficiaries. USFHP and CPD enrollees should contact
their contractor's designated nurse advice line. Beneficiaries residing
overseas can call the NAL for health care advice when traveling in the
U.S. but must coordinate care with their Overseas Regional Call Center.
For additional information, call the servicing TRICARE contractor or
visit <a href="https://www.tricare.mil/ContactUs">https://www.tricare.mil/ContactUs</a> and click on ``MHS Nurse Advice
Line.''
Prime Service Area Changes: Prime Service Areas (PSAs) are
geographic areas around military medical treatment facilities and Base
Realignment and Closure sites where TRICARE Prime is available. PSAs
support the medical readiness of active duty members of the Uniformed
Services by adding to the capability and capacity of military hospitals
and clinics. There are no changes to the existing PSAs for CY 2026.
What's New
The following changes or improvements to TRICARE program benefits
apply to CY 2026 (although some changes were implemented in 2025):
Changes to Automatic Prescription Refill Procedures for Mail Order
Pharmacy: TRICARE beneficiaries using the mail order pharmacy must
confirm they want their prescriptions refilled before the drugs are
dispensed to prevent beneficiaries from receiving automatic refills for
medications they no longer require and accruing unnecessary cost-
shares. Beneficiaries will receive a notification in an email or text
when a prescription is due for a refill, and they must log in to their
account to confirm the request. When a beneficiary declines a refill or
does not respond, the prescription will be removed from the automatic
refill program, but the beneficiary will continue receiving reminder
notifications their prescriptions are ready to refill until such
prescription expires.
Elimination of Cost-Sharing for all TRICARE-Covered Contraceptives
under the TRICARE Pharmacy Program: DoD eliminated cost-sharing for all
TRICARE-covered contraceptives under the TRICARE Pharmacy Benefit
program pursuant to authority granted to the Department under Section
707 of the Servicemember Quality of Life and National Defense
Authorization Act (NDAA) for Fiscal Year (FY) 2025, making it easier
for beneficiaries to access necessary contraceptive care.
Coverage of Weight Loss Drugs for Treating Obesity: TRICARE is
authorized to cover weight loss drugs for treating obesity, if obesity
is the sole or major condition treated, only for TRICARE Prime and
Select beneficiaries when such weight loss drugs are prescribed by a
TRICARE network provider and are medically necessary and appropriate,
and integrated into a comprehensive medical treatment plan. The TRICARE
Pharmacy Benefit program significantly revised the prior authorization
forms for these drugs (e.g., GLP-1s) to continue to afford legally
permissible coverage to our eligible beneficiaries while curtailing
inappropriate use of these drugs and potential fraud, waste, and abuse.
Exclusion of Hormone Therapy for Treating Gender Dysphoria in
Minors: Pursuant to NDAA for FY 2025, Section 708, and Executive Order
14187, for beneficiaries who are 18 years of age or younger, TRICARE no
longer covers puberty blockers to delay the onset or progression of
normally timed puberty and the use of sex-hormones to align an
individual's physical appearance with an identity differing from his or
her sex.
TRICARE Reserve Select, TRICARE Young Adult Survivor Coverage
Eligibility: Pursuant to NDAA for FY 2024, Section 702, for Selected
Reserve (SelRes) members enrolled in TRICARE Reserve Select (TRS) on or
after October 1, 2025, eligible surviving family members may purchase
new or continue existing TRS coverage for up to three years from the
date of the SelRes member's death if the SelRes member's death occurred
on or after October 1, 2025. For SelRes members enrolled in TRS on or
after October 1, 2025, surviving young adult dependents may qualify to
purchase TYA coverage, but with survivor (retiree) cost-shares, up to
three years after the Service member's death or until the young adult
dependent reaches the age of 26, whichever occurs first, if the SelRes
member's death occurred on or after October 1, 2025.
TRICARE Prime Enrollment Fee Waiver Limitations: The TRICARE Prime
enrollment fee waiver policy is updated clarifying waiver eligibility
limits. The TRICARE Prime enrollment fee waiver is available only to
Group A Medicare-eligible retirees and their family members enrolled in
Medicare Part B. Group A consists of beneficiaries whose sponsor
originally entered a uniformed service before January 1, 2018. All
Group B Medicare-eligible beneficiaries and their family members are
required to pay the TRICARE Prime enrollment fee.
Drive Time Standard Waiver No Longer Required for TRICARE Prime:
Beneficiaries enrolled in TRICARE Prime who move within 100 miles of a
military medical treatment facility (MTF) but at least 30 minutes away
by car no longer need to request a waiver to stay enrolled in TRICARE
Prime, the managed-care health plan option. However, beneficiaries
moving farther than 100 miles of their MTF will need to make
affirmative enrollment decisions or risk losing access to their TRICARE
benefit.
Benefit Improvements
Female Uterine Fibroids Procedures: Laparoscopic or transcervical
radiofrequency ablation for symptomatic uterine fibroids may be covered
with TRICARE beneficiary cost-sharing when the procedure is performed
using a Food and Drug Administration (FDA)-approved device according to
manufacturer guidelines.
Lung Malignancy Treatment: Cryoablation, also called cryotherapy or
[[Page 48730]]
cryosurgery, may be covered for treating lung malignancies in patients
with lung cancer and in patients whose primary cancers have
metastasized to the lungs. Cryoablation for lung malignancies may be
covered as a curative or palliative treatment.
Transcutaneous Electrical Nerve Stimulation: Transcutaneous
electrical nerve stimulation (TENS) devices are covered for acute post-
operative pain for 30 days following surgery, or up to 90 days with
preauthorization. TRICARE also covers TENS replacement supplies based
on Medicare's frequency limits.
Coronary Calcium Scoring: Coronary artery calcium scoring when
medically necessary for treating a patient who is asymptomatic for
atherosclerotic cardiovascular disease is covered when provided in
accordance with American College of Cardiology and American Heart
Association guidelines.
Basivertebral Nerve Ablation: Basivertebral Nerve Ablation, a
procedure to relieve chronic vertebrogenic lower back pain for patients
with degenerative disc disease or other spinal conditions, is covered.
Risk-Reducing Surgeries: Expanded coverage of prophylactic
mastectomies, prophylactic oophorectomies, and prophylactic
hysterectomies for patients meeting criteria specified in American
College of Obstetricians and Gynecologists or National Comprehensive
Cancer Network guidelines, including personal and family cancer
history, pathogenic or likely pathogenic genetic variants such as
BRCA1/2 and PALB2, hereditary cancer syndromes such as Lynch Syndrome
and Hereditary Breast and Ovarian Cancer Syndrome, and chest radiation.
Expediting Cochlear Implantation for Certain Children: TRICARE is
eliminating the requirement children undergo a three-to-six-month
hearing aid trial prior to receiving cochlear implants for children
with post-meningitis hearing loss, evidence of cochlear ossification,
and those with bilateral severe-to-profound sensorineural hearing loss.
Human Papillomavirus Testing: Primary human papillomavirus (HPV)
testing without co-testing (e.g., simultaneous HPV testing with a pap
test) is covered for beneficiaries ages 30-65 every five years.
Additionally, for beneficiaries ages 30-65, co-testing every five years
and pap tests every three years are covered. For beneficiaries ages 21-
29, pap tests are covered every three years. FDA-approved self-
collection tests are also covered.
Clinical Trials Coverage Expansion: Effective August 27, 2025,
TRICARE covers routine care provided as part of clinical trials
sponsored or approved by the National Institutes of Health studying
conditions that are severely debilitating, life-threatening, or a rare
disease, and for clinical trials studying infectious diseases for which
a Public Health Emergency or National Emergency was declared.
New Provisional Coverage
Monoclonal Antibodies for Treating Alzheimer's Disease: TRICARE
extended provisional coverage for monoclonal antibody drugs (e.g.,
lecanemab and donanemab) for treating the mild cognitive impairment or
mild dementia stage of Alzheimer's disease beginning on October 23,
2024, for a five-year period, when used in accordance with FDA-approved
labeling and when care is preauthorized. These drugs target the protein
plaques presenting in the brain of Alzheimer's patients. In addition to
otherwise covered confirmatory testing (e.g., cerebral spinal fluid
testing), confirmation of target protein biology may be obtained
through positron emission tomography (i.e., PET) scans under this
provisional coverage.
Demonstration Changes and Extensions
Competitive Plans Demonstration: TRICARE-eligible active duty
family members, retirees, and retiree family members who reside within
certain ZIP Codes in the metro Atlanta, Georgia, and metro Tampa,
Florida, areas can opt to voluntarily enroll in any year of a
Competitive Plans Demonstration (CPD) that begins January 1, 2026 and
ends December 31, 2028, regardless of whether they are currently
enrolled in TRICARE Prime or TRICARE Select. Qualifying beneficiaries
who wish to participate in the CPD can select the TRICARE Prime option
with CareSource Military & Veterans (CSMV) serving as the contractor
assigning the beneficiaries' primary care managers, and MicroHealth
providing enrollment support and associated customer service
operational support. CSMV will apply standard TRICARE Prime enrollment
fees, copays, cost shares, deductibles, and catastrophic caps--except
that the applicable annual TRICARE enrollment fee will be waived for
TRICARE beneficiaries for the first year in which they enroll as CPD
participants. Beneficiaries participating in the CPD will fill
outpatient pharmacy prescriptions through the TRICARE Pharmacy Program
managed by Express Scripts or at MTF pharmacies.
CSMV will provide enrollees access to its network primary care and
specialty care providers (both inpatient and outpatient) in the
Atlanta, Georgia, and Tampa, Florida, markets as well as virtual
visits. Standard preauthorization requirements will apply; however, the
TRICARE Prime referral requirements will not apply. The TRICARE POS
option, with its associated cost-sharing requirements, will be
available to CPD-enrolled beneficiaries. Details are available in an
April 28, 2025, Federal Register notice at <a href="https://www.federalregister.gov/documents/2025/04/28/2025-07258/tricare-tricare-competitive-plans-demonstration-cpd">https://www.federalregister.gov/documents/2025/04/28/2025-07258/tricare-tricare-competitive-plans-demonstration-cpd</a>.
Appendix A
Certain TRICARE enrollee out-of-pocket costs (enrollment fees,
premiums, catastrophic caps, deductibles, and copayments) are adjusted
annually by Federal law and regulations based on the annual Cost of
Living Adjustment (COLA) applied to Uniformed Service member retired
pay. A difference in copayments remains between those who entered a
Uniformed Service before January 1, 2018, (Group A), and those who
entered on or after that date (Group B).
The retiree COLA is typically announced after the Federal fiscal
year begins in October. Beneficiary out-of-pocket expenses impacted by
the 2025 COLA will be posted to the <a href="http://tricare.mil/changes">tricare.mil/changes</a> web page before
the start of TRICARE Open Season, November 10, 2025.
Premium Based Plans
The CY 2026 monthly premiums for TRICARE Reserve Select, TRICARE
Retired Reserve, and TRICARE Young Adult and the quarterly premiums for
Continued Health Care Benefit Program will be posted to the
<a href="http://tricare.mil/changes">tricare.mil/changes</a> web page once announced.
Pharmacy Out-of-Pocket Expenses for CY 2026
TRICARE Pharmacy copayments will increase January 1, 2026:
[[Page 48731]]
Pharmacy Copayments for Calendar Year 2026 *
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Retail
Retail network network Mail order
Retail network brand-name non- Mail order generic brand-name Mail order non-
Year generic formulary formulary 30- formulary formulary 90-day formulary 90- formulary 90-
30-day supply day supply 30-day supply day supply day supply
supply
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2026....................................... $16 $48 $85 ** $14 $44 $85
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* Active duty Service members (ADSM) enjoy a $0 copay for covered drugs at any pharmacy.
** For all beneficiaries except ADSM, select brand-name maintenance medications (taken for long-term conditions) may only be filled twice at retail and
then must be filled through home delivery or military pharmacy.
Dated: October 23, 2025.
Aaron T. Siegel,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 2025-19672 Filed 10-27-25; 8:45 am]
BILLING CODE 6001-FR-P
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