Benefits Overview

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.

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

$11

$7
Formulary

$28

$24
Non-Formulary

$53

$53

Copayments will change effective Jan. 1, 2020:

Retail Network Pharmacy Copayment Changes (up to 30-day supply)

  • Generic formulary drugs will increase from $11 to $13.
  • Brand-name formulary drugs will increase from $28 to $33.
  • Non-formulary drugs will increase from $53 to $60. (Please note:  Non-formulary drugs are generally only available through home delivery.)   

Home Delivery Copayment Changes (up to 90-day supply)

  • Generic formulary drugs will increase from $7 to $10.
  •  Brand-name formulary drugs will increase from $24 to $29.
  • Non-formulary drugs will increase from $53 to $60.

Beneficiaries can still fill their prescriptions for $0 copay at MTF pharmacies.

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 (link to 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.

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 on TRICARE.mil.

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 on TRICARE.mil.

 


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.