Member Choice Center

The Member Choice Center makes it easy to reduce your out-of-pocket costs by transferring your current maintenance medication prescriptions to the Mail Order Pharmacy. If you prefer the convenience of home delivery, contact the Member Choice Center to convert your current retail or MTF prescriptions to the Mail Order Pharmacy.  Mail-order copayments apply.

Visit Express Scripts' web site and click on the “Make the Switch to Mail Order Pharmacy Home Delivery” feature, or call 1-877-363-1433 to get started. Note: To use the Member Choice Center, you must have a maintenance prescription dispensed at a retail pharmacy or MTF. The Member Choice Center will contact your provider to obtain a new written prescription for home delivery.
     

TRICARE Retail Network Pharmacies

Another option for filling your prescriptions is through TRICARE retail network pharmacies. You may fill prescriptions (one copayment for each 30-day supply) when you present your written prescription and your uniformed services ID card to the pharmacist.

This option allows you to fill your prescriptions at TRICARE network pharmacies across the country without having to submit a claim. You have access to a network of approximately 60,000 retail pharmacies in the United States and its territories (including Guam, the Northern Mariana Islands, Puerto Rico, and the U.S. Virgin Islands). To find the nearest TRICARE retail network pharmacy, visit the Express Scripts web site or call 1-877-363-1303.
          

Non-Network Pharmacies

At non-network pharmacies, you will pay the full price of your medication up front and file a claim for reimbursement. Reimbursements are subject to deductibles, out-of-network cost-shares, and TRICARE-required copayments. All deductibles must be met before any reimbursement can be made. For details about filing a claim, see the Claims section.
     

Quantity Limits

TRICARE has established quantity limits on certain medications, which means the Department of Defense (DoD) will only pay for up to a specified, limited amount of medication each time you fill a prescription. Quantity limits are often applied to ensure medications are safely and appropriately used. Exceptions to established quantity limits may be made if the prescribing provider is able to justify medical necessity.
         

Prior Authorization

Some drugs require prior authorization from Express Scripts. Medications requiring prior authorization may include, but are not limited to, prescription drugs specified by the DoD Pharmacy and Therapeutics Committee, brand-name medications with generic equivalents, medications with age limitations, and medications prescribed for quantities exceeding normal limits. For a general list of prescription drugs that are covered under TRICARE, and for drugs that require prior authorization or that have quantity limits, visit TRICARE's Formulary Search Tool.
     

Generic Drug Use Policy

Generic drugs are medications approved by the U.S. Food and Drug Administration (FDA) and clinically equivalent to brand-name medications. Generic drugs provide the same safe, effective treatment as brand-name drugs. It is DoD policy to use generic medications instead of brand-name medications whenever possible. A brand-name drug with a generic equivalent may be dispensed only after the prescribing physician completes a clinical assessment that indicates use of the brand-name drug is medically necessary and after Express Scripts grants approval. If a generic-equivalent drug does not exist, the brand-name drug will be dispensed at the brand-name copayment. If you fill a prescription 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.
    

Non-Formulary Drugs

The DoD Pharmacy and Therapeutics Committee may recommend to the Director of the TRICARE Management Activity that certain drugs be placed in the third, “non-formulary” tier. These medications include any drug in a therapeutic class determined to be not as relatively clinically effective or as cost-effective as other drugs in the same class. For an additional cost, third-tier drugs are available through the Mail Order Pharmacy or retail network pharmacies. You may be able to fill non-formulary prescriptions at formulary costs if your provider can establish medical necessity by completing and submitting the appropriate TRICARE pharmacy medical necessity form for the non-formulary medication. Forms and medical necessity criteria are available online or by calling Express Scripts at 1-877-363-1303.

To learn more about medications and common drug interactions, check for generic equivalents, or determine if a drug is classified as a non-formulary medication, visit the TRICARE Formulary Search Tool.

For information on how to save money and make the most of your pharmacy benefit, visit TRICARE's prescription portal or Express Scripts' web site.
         

Specialty Medication Care Management

Specialty medications are usually high-cost; self-administered; injectable, oral, or infused drugs that treat serious chronic conditions (e.g., multiple sclerosis, rheumatoid arthritis, hepatitis C). These drugs typically require special storage and handling, are difficult to administer, and are not readily available at your local pharmacy. Specialty medications may also have side effects that require pharmacist and/or nurse monitoring.

The Specialty Medication Care Management program is structured to improve your health through continuous health evaluation, ongoing monitoring, assessment of educational needs, and management of medication use. This program provides:

• Access to proactive, clinically based services for specific diseases designed to help you get the most benefit from your medication
• Monthly refill reminder calls
• Scheduled deliveries to your specified location
• Specialty consultation with nurse/pharmacist at any point during your therapy

These services are provided to you at no additional cost when you receive your medications through the Mail Order Pharmacy, and participation is voluntary. If you or your provider orders a specialty medication from the Mail Order Pharmacy, you will receive additional information from Express Scripts about the Specialty Medication Care Management program and how to get started. 

Using the Mail Order Pharmacy to fill specialty medication prescriptions provides you with access to the Specialty Medication Care Management program benefits described above. You may submit a specialty medication prescription by mail, or your provider may submit it by fax. If you are currently using another pharmacy to fill your specialty medication prescription, you can contact the Member Choice Center at 1-877-363-1433 to switch to the Specialty Medication Care Management program.With specific mailing instructions from you or your provider, the Mail Order Pharmacy will ship your specialty medication to your home. For your convenience and safety, the Mail Order Pharmacy will contact you to arrange delivery before the medication is shipped.

Note: Some specialty medications may not be available through the Mail Order Pharmacy because the medication’s manufacturer limits the drug’s distribution to specific pharmacies. If you submit a prescription for a limited-distribution medication, the Mail Order Pharmacy will either forward your prescription to a pharmacy of your choice that can fill it or will provide you with instructions about where to send the prescription to have it filled. To determine if your specialty medication is available through the Mail Order Pharmacy, visit the TRICARE Formulary Search Tool.

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