How to use your benefit
Home Delivery
The most efficient way to fill prescriptions that you take for long-term or chronic conditions is through Express Scripts Pharmacy®. Learn more about getting started with home delivery.
If you receive specialty medication through the TRICARE Home Delivery Pharmacy Program, you have the benefits of our Specialty Medication Care Management Program. The Specialty Medication Care Management Program connects you with nurses, pharmacists and patient care advocates who specialize in your condition.
Accredo specialty pharmacy is now in-network for TRICARE beneficiaries. On January 1st, 2023, Accredo will be the TRICARE in-network specialty pharmacy. We encourage you to take action to move your specialty medications ahead of this date to avoid disruption in your medication therapy and increased out-of-pocket costs using a non-network pharmacy.
Retail
Your retail plan should be used for medications required on a short-term basis. When you have a prescription filled at a participating pharmacy, present your Military I.D. card to the pharmacist, who will use an automated system to verify your coverage and prescription cost.
Days Supply
Home Delivery
Through the TRICARE Home Delivery Pharmacy Program, you can purchase up to a 90-day supply of most prescription medications. There may be limitations on some prescriptions, such as controlled medications, subject to state and federal dispensing limitations.
Retail
At retail pharmacies, you may purchase up to a 90-day supply of most prescription medications. There may be limitations on some prescriptions, such as controlled medications, subject to state and federal dispensing limitations.
Copayments
Copayments for Active Duty Personnel
| Type of Drug | 30-Day Supply Retail Pharmacy | 90-Day Supply Home Delivery |
| Generic1 | $0 | $0 |
| Formulary | $0 | $0 |
| Non-Formulary | Approval Required2 | Approval Required2 |
Copayments for All Other Beneficiaries
| Type of Drug | 30-Day Supply Retail Pharmacy | 90-Day Supply Home Delivery |
|---|---|---|
| Generic |
$14 |
$12 |
| Formulary |
$38 |
$34 |
| Non-Formulary |
$68 |
$68 |
Copayments will change on January 1, 2022. Beneficiaries can still fill their prescriptions at MTF pharmacies for $0 copayment.
Log in to find pricing and coverage for a specific medication.
Non-Covered Drugs
Non-covered can be filled at any retail pharmacy. You are responsible for paying the full cost of the drug. The amount you pay for an excluded drug won’t apply to your catastrophic cap. Non-covered drugs are not available at military pharmacies or through home delivery. For information about your drug, including its coverage status, visit the TRICARE Formulary Search Tool.
File a Prescription Claim
To request reimbursement for a prescription, log in to download the Prescription Claim Form and follow the instructions. Please note: Form submission does not guarantee coverage.
NEW: File a Claim Online
To submit a claim online, log in to your account and navigate to the ‘Benefits’ menu option and select ‘Forms’.
Be sure to have your prescriber information handy, a photocopy of your pharmacy receipt and the phone number for the pharmacy you filled your prescription at.
Learn More About Prior Authorization
Prior Authorization is a program that helps you get prescription drugs you need with safety, savings and your good health in mind. Learn more about the program and download a claim form for your doctor through the TRICARE Formulary Search Tool.
File a Medical Necessity Claim
Proof of Medical Necessity is required for some drugs. In other cases, you may be eligible for a lower copayment if your doctor completes a medical necessity form. Download a medical necessity form through the TRICARE Formulary Search Tool.
1. Occasionally, some generic medications may be considered non-formulary. Non-formulary generics will be subject to the non-formulary copayments listed above. Your doctor can submit evidence of medical necessity for these drugs. If evidence of medical necessity is approved, the formulary copayment from above will apply.
2. Active duty personnel may obtain non-formulary drugs only after receiving approval of evidence of medical necessity. This information should be submitted along with your prescription.
Note: Some prescriptions may require prior authorization, may be subject to a quantity limit per prescription, or may not be covered by your plan.
This website provides general information about your prescription drug benefit. If any information on this site conflicts with the plan documents that govern your benefit, such documents take precedence in all cases.