If you have other health insurance (OHI), you will need to submit pharmacy claims to Express Scripts, Inc. (ESI) for payment. For TRICARE Standard/Extra, before reimbursement is granted for non-network pharmacy claims, you must meet an annual TRICARE deductible.
 
Pharmacy claims must be filed within one year of the date of service. To file a pharmacy claim, obtain and fill out a DD Form 2642 Patient’s Request for Medical Payment (link to Claims Form on HMHS Site). Prescription claims require the following information for each drug:

• Name of the patient
• Name, strength, date filled, days' supply, quantity dispensed, and price of each drug
• National Drug Code, if available
• Prescription number of each drug
• Name and address of the pharmacy
• Name and address of the prescribing physician

  
Mail the claim to:
Express Scripts, Inc.
TRICARE Claims
P.O. Box 66518
St. Louis, MO 63166-6518
 
Call 1(866) DoD-TRRx (1-866-363-8779) with questions about filing a pharmacy claim.