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TRICARE Reserve Select Handbook
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Pharmacy Services
Military Treatment Facility Pharmacy
TRICARE Mail Order Pharmacy
TRICARE Retail Pharmacy Network
Non-network Pharmacy
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. If your pharmacist asks for your insurance card, you should provide your TRS wallet card. 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 pharmacy to find out what is on the formulary and for specific details about filling prescriptions there. |
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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. Registering for the mail-order pharmacy is easy:
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- Register online. Go to the TRICARE Web Site and click on “Filling Prescriptions.” Then select “How to Register” in the left-hand navigation column. Complete the online registration form and follow the instructions for submission.
- Register by phone. Call 1-866-363-8667 (in the United States). If overseas, call 1-866-ASK-4PEC (1-866-275-4732).
- Register by mail. Download the registration form on the TRICARE Web Site and mail it to:
TRICARE Mail Order Pharmacy
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 may register before placing your first order. Once you are registered, your provider can fax or call in your prescriptions.
You can convert maintenance prescriptions (prescriptions you take on a regular basis ) that you have filled at a TRICARE Retail Network Pharmacy to the TRICARE Mail Order Pharmacy via the Member Choice Center (MCC). To convert online, go to the TRICARE Web Site and click on "Filling Prescriptions." Then select "Convert Retail Prescriptions" in the left-hand navigation column and follow the instructions to convert online. To convert by phone, call 1-877-363-1433. A trained MCC Patient Care Advocate will walk you through the process and convert your medication(s) to home delivery.
Your medications will be sent directly to your home within approximately 14 days after your prescription is received. If you have prescription drug coverage from another health insurance plan, you can 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. For more information or to locate a TRICARE retail network pharmacy, call 1-866-DoD-TRRX (1-866-363-8779) or visit the TRICARE Web Site.
Note: Retail network pharmacies are available in the United States, American Samoa, Guam, the Northern Mariana Islands, Puerto Rico, and the U.S. Virgin Islands.
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Non-network Pharmacy |
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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 to receive a partial reimbursement from TRICARE after your deductible is met. (For more information about pharmacy claims, 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 that the Department of Defense (DoD) will only pay for a specified amount (a 30-, 60-, or 90-day supply ) of medication. Quantity limits are applied to ensure the medications are safely and appropriately used. Exceptions to established quantity limits may be made if the prescribing provider is able to justify medical necessity.
Some drugs require prior authorization. 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 and click on “Medications.” Then, from the left-hand navigation bar, select “Prior Authorization.” If You can also 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 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 determined to be not as clinically effective or not as cost-effective as other drugs in its therapeutic class may be recommended for placement in the “non-formulary” classification. Non-formulary drugs are available to beneficiaries from the mail-order or retail pharmacies at a higher cost. You may be able to have nonformulary prescriptions filled at the formulary costs if your provider can establish medical necessity. Note: Non-formulary drugs are generally not available at MTFs.
To learn more about medications and common drug interactions, to check for generic equivalents, or to determine if a drug is classified as a non-formulary medication, visit the online TRICARE Formulary Search Tool.
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) and select option seven for pharmacy details.
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