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Beneficiary Standard Handbook
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Pharmacy Services
Military Treatment Facility Pharmacy
TRICARE Mail Order Pharmacy
TRICARE Retail Pharmacy Network
Non-network Pharmacies
Quantity Limits and Prior Authorization
Generic Drug Use Policy
Non-formulary Drugs |
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Pharmacy Services |
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TRICARE offers comprehensive prescription drug coverage and several options for filling your prescriptions. To have a prescription filled, you’ll need a written prescription and a valid uniformed services ID card. Refer to the TRICARE: Summary of Beneficiary Costs flyer or visit the TRICARE Web site for pharmacy cost information.
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Military Treatment Facility Pharmacy |
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Prescriptions may be filled (up to a 90-day supply for most medications) at an MTF pharmacy at no cost as long as the medication is on the MTF formulary. You should contact the MTF to find out what is on the formulary and for specific details about filling prescriptions at the MTF pharmacy. If you do not live near an MTF, this may not be your best option for filling prescriptions. |
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TRICARE Mail Order Pharmacy |
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The mail-order pharmacy is your least expensive option when not using the MTF. You may receive up to a 90-day supply for most medications delivered to your home for a small copayment. Refills may be requested by mail, phone, or online. Express Scripts, Inc. (ESI), administers the mail-order pharmacy, and registering is easy.
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- Register online. Complete the registration form and follow the instructions available on the Express Scripts Web site.
- Register by phone. Call 1 (866) 363-8667.
- Register by mail. Download the form at the Express Scripts Web site and mail it to:
P.O. Box 52150
Phoenix, AZ 85072-9954.
Include the written prescription and the appropriate copayment when you mail your registration.
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For faster processing of your mail-order prescription, you can register before placing your first order. Once you are registered, your provider can fax or call in your prescriptions.
ESI will send your medications directly to your home within about 14 days after receiving your prescription. If you have prescription drug coverage from another health insurance plan, you can only use the mail-order pharmacy if the medication is not covered under the other plan or if you exceed the dollar limit of coverage under the other plan.
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TRICARE Retail Pharmacy Network |
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You can have prescriptions filled (up to a 30-day supply) at any pharmacy in the TRICARE retail pharmacy network for a small copayment. ESI also administers the retail pharmacy network. For more information or to locate a TRICARE network pharmacy near you, call 1 (866) DoD-TRRx
(1 (866) 363-8779) or visit the Express Scripts Web site.
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Non-network Pharmacies |
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Filling prescriptions at a non-network pharmacy is the most expensive option. You may have to pay for the total amount first and then file a claim with ESI to receive a partial reimbursement after your deductible is met. (For pharmacy claims information, see the Claims section.) |
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Quantity Limits and Prior Authorization |
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TRICARE has established quantity limits on certain medications, which means the DoD will pay only for up to a specified quantity per 30-, 60-, or 90-day supply. Quantity limits are applied to ensure the medications are safely and appropriately used. Exceptions to established quantity limits might be made if the prescribing provider is able to justify medical necessity.
Some drugs require prior authorization from ESI. For a general list of prescription drugs that are covered under TRICARE and for drugs requiring prior authorization or having quantity limits, visit the TRICARE Web site or call toll-free 1 (866) DoD-TRRx (1 (866) 363-8779) or 1 (866) DoD-TMOP
(1 (866) 363-8667).
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Generic Drug Use Policy |
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It is DoD policy to use generic medications, instead of brand-name medications, whenever possible. Brand-name drugs that have a generic equivalent may be dispensed only if the prescribing physician is able to justify medical necessity for use of the brand-name drug in place of the generic equivalent. If a generic equivalent drug does not exist, the brand-name drug will be dispensed at the brand-name copayment. If you insist on having a prescription filled with a brand-name drug that is not considered medically necessary, and when a generic equivalent is available, you will be responsible for paying the entire cost of the prescription out of pocket. |
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Non-formulary Drugs |
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Any drug in a therapeutic class determined to be not as relatively clinically effective or not as cost-effective as other drugs in the class may be recommended for placement in the third, “non-formulary” tier. Drugs in the third tier are available to beneficiaries from the mail-order or retail pharmacies, but at a higher cost. You may be able to have non-formulary prescriptions filled at formulary costs if your provider can establish medical necessity.
To learn more about any medication and common drug interactions, to check for generic equivalents or to determine if a drug is classified as a non-formulary medication, visit the TRICARE Formulary Web site.
For information on how to save money and make the most of your pharmacy benefit, visit the TRICARE Web site or call 1 (877) DoD-MEDS (1 (877) 363-6337).
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