Frequently Asked Questions
- Who is Express Scripts?
- How do I start using TRICARE Pharmacy Home Delivery?
- How do I refill a current prescription using TRICARE Pharmacy Home Delivery?
- Where can Express Scripts ship my order?
- If I use TRICARE Pharmacy Home Delivery, can I still use the Military Treatment Facility (MTF) and retail pharmacies?
- Can Express Scripts dispense medications that need to be refrigerated?
- I live apart from my sponsor. Can I establish a separate account?
- How do I cancel or return an order?
- How do I submit my new prescription?
- Where can I get a prescription order form?
- Does my doctor need to write my prescription a certain way?
- What information needs to be on my written prescription?
- Can I submit prescriptions written by any doctor?
- If my doctor faxes in a new prescription, do I still have to fax/mail in the prescription order form?
- Can I fax in my own prescription to Express Scripts?
- How do I move my current prescription to a different local pharmacy?
- When can I refill my Home Delivery prescription?
- What if I am told it's too early to fill my prescription?
- When does my prescription expire?
- If my prescription is NOT a compound or controlled medication, do I have to speak with a patient care advocate to order a refill?
- My family member/caregiver handles my medications; can he/she contact Express Scripts for me and order my medication?
- When will I receive my prescription order?
- How do I check the status of an order?
- What could cause my prescription order to be delayed?
- Where will my prescription order be delivered?
- Can I request rush shipping for my prescription order?
- What do I do if I have more than one address?
- What if I want to use Home Delivery, but I need to start my maintenance medications immediately?
- What if I am low or out of my medication and need immediate assistance?
- How do I know if my compound drug is covered?
- Why is my compound prescription rejecting?
- How do I request prior authorization for a compound drug?
- Where can I find more information on compound drug coverage?
- If I meet my Catastrophic Cap requirement for the year, will I still be charged a copayment for a non-formulary medication?
- What does it mean if my pharmacist says "prior authorization" is needed?
- Why isn't my prescription covered under my plan?
- Do some prescription drugs cost more or have additional requirements for coverage?
- How do I pay for my prescription order?
- What is a copayment?
- How much are my copayments?
- Why was I charged a non-formulary copayment for a generic drug?
- Who do I contact with billing questions?
- How much do I pay for each prescription?
- How can I change the payment information for my account?
- What is a formulary?
- How do I find out if the drug I need is on the formulary, has a prescribing restriction or requires prior authorization?
- Why is a medication not included on the formulary?
- What is a non-formulary or non-preferred drug?
- Why is a drug not included on my formulary?
- What are generic drugs?
- What is "generic substitution"?
- Does TRICARE Pharmacy Home Delivery require generic substitution?
- How can I know when a generic drug is available?
- What if my doctor prescribes a brand-name drug, but my plan requires generic substitution?
- Why do some generic drugs look different than their brand-name versions?
- If generic drugs are just as good as brand-name drugs, why do generics cost less?
- Are there reasons to stick with a brand-name drug even if there is a generic on the market?
- What about the companies that make generic drugs? Are they as trustworthy as the companies that make the brand-name drugs?
- Why aren't all prescription drugs available in a generic version?
- What is Other Health Insurance (OHI)?
- How does my TRICARE pharmacy benefit work with my other health insurance?
- Do I have to notify Express Scripts that I have OHI?
- How does my OHI work with TRICARE Pharmacy Home Delivery?
- What should I do if I meet one of the above three requirements?
- What do I need to know about OHI and using TRICARE retail network pharmacies?
- Do supplemental and discount prescription drug programs, such as Senior Friends and AARP, count as OHI pharmacy coverage?
- Should I keep my receipts to submit for reimbursement?
- What if I am a National Guard or Reserve member?
- Why do I need to provide personal information during the online account activation process?
- Why does Express Scripts require that I keep personal information on file on its website?
- How does Express Scripts ensure that my personal information is safe and that my online transactions on its website are secure?
- How do I change my e-mail address or other profile information?
- Why did I receive an e-mail message from Express Scripts or one of its companies that told me to click a link or "pick up a packet" from another site?
- What recourse do I have if it is determined that I suffer a financial loss due to someone stealing my information from Express Scripts?
- Does Express Scripts store my social security number on its systems when I register?
- When I place my prescription order, am I required to provide my credit card information if I am on active duty?
- I am on Active Duty. Will I have to pay the non-formulary copayment for a non-formulary medication at Home Delivery?
- If I am on Active Duty and do not wish to obtain medical necessity approval, can I pay the non-formulary copayment and obtain the non-formulary medication?
- How do deployed service members update their mailing address with TRICARE Pharmacy Home Delivery?
- I've recently been deployed. Why can't I view the status of my refill?
- Are National Guard/Reserve personnel and their families eligible?
- As a National Guard/Reserve member on Title 10 (or 32) orders for 120 days, how do I ensure coverage?
- Are National Guard/Reserve personnel who were on Active Duty under Title 10 and have been discharged from active duty entitled to coverage for Home Delivery or retail coverage under the TRICARE Reserve Select (TRS) Program?
- What is the Uniform Formulary?
- What is the copayment structure under the Uniform Formulary?
- How can I find out which drugs are considered non-formulary?
- How can I continue paying the formulary copayment for my non-formulary medication?
- How do I obtain medical necessity approval?
- Once medical necessity is established, will my approval expire?
- If I obtain medical necessity for a non-formulary drug under TRICARE Pharmacy Home Delivery, will the same override work at a retail pharmacy?
- My prescription and medical necessity form have been sent to Express Scripts. How will I know if medical necessity approval was granted?
- If I previously obtained medical necessity approval for a non-formulary medication, will it be grandfathered?
- Who is eligible?
- How do I get a prescription for smoking cessation drugs?
- Which medications are covered?
- How many quit attempts are covered?
- What if I get the drugs from a network retail pharmacy?
- I don't currently use TRICARE Pharmacy Home Delivery but would like to get started and take advantage of this program. What do I do?
- If I receive smoking cessation drugs through Home Delivery, can I still fill my other prescriptions at a retail pharmacy?
About Express Scripts
Who is Express Scripts?
Express Scripts makes the use of prescription drugs safer and more affordable for tens of millions of consumers through thousands of employers, government, union and health plans. Express Scripts handles millions of prescriptions each year through Home Delivery and at retail pharmacies.
Prescription Home Delivery
How do I start using TRICARE Pharmacy Home Delivery?
It's easy. Just follow the instructions below:
- To get started by placing an order, sign in to your account and navigate to the forms page by selecting Print Forms from Health & Benefits Information in the menu. Here you can print out an order form to mail along with your written prescription, or blank fax form that your doctor can fill in and fax to us with the prescription.
- To get started without placing an order, register your online account. Once registered, you can sign in to your account and your prescriptions which are eligible to be transferred to Home Delivery will be visible in the Prescriptions section of the home page.
How do I refill a current prescription using TRICARE Pharmacy Home Delivery?
Order Online: You can order refills quickly and easily using your online account. Payment by check card or credit card is required unless you are an active duty member.
Order by Phone: Quickly order refills using the toll-free number on your prescription bottle. Payment by check card or credit card is required.
Order by Mail: When you fill your prescription with Express Scripts, a refill form is included with your first shipment. Use the envelope provided to mail the refill form to Express Scripts. You should mail your refill form about three weeks before your current supply will run out. If you mail your form before then, your order may be delayed. Also, make sure your prescription has not expired.
Include your payment with your order. For your convenience and to ensure delivery of your prescription without delay, you are encouraged to provide your check card or credit card information on your refill form. Express Scripts accepts Visa, MasterCard, Discover and American Express. Your check card or credit card account will be billed automatically upon processing your order. If you have not provided your card information, you may enclose a personal check or money order for your payment amount.
Your last refill will include a renewal form with instructions for receiving future refills of your medication.
Note: A complete street address is required for controlled substance medications and an adult signature is required upon receipt. Controlled substances cannot be shipped to a PO Box.
Where can Express Scripts ship my order?
Express Scripts ships to the following destinations:
- All 50 states
- PO boxes
- APO/FPO addresses
- U.S. territories
If I use TRICARE Pharmacy Home Delivery, can I still use the Military Treatment Facility (MTF) and retail pharmacies?
Yes. Using the Home Delivery pharmacy doesn't prevent you from using MTF pharmacies or a pharmacy in the TRICARE Retail Network. In fact, using an MTF pharmacy is recommended because it's the most cost-effective way — both for you and the DoD — to get prescription drugs. You should also use an MTF or retail network pharmacy for prescriptions you will take only once or need to begin immediately, such as an antibiotic.
Can Express Scripts dispense medications that need to be refrigerated?
Yes. Express Scripts will ship medications requiring refrigeration in cold packs. Please note, refrigerated medications cannot be shipped to APO/FPO addresses.
I live apart from my sponsor. Can I establish a separate account?
Yes. Each DoD beneficiary must set up their own online account. Activate your account online now or call us at 877.363.1303 to arrange for a separate account.
How do I cancel or return an order?
To cancel or return an order, please contact Express Scripts for instructions and refund or replacement guidelines. There are specific requirements that must be met before an order can be approved for return.
Ordering & Refilling Prescriptions
How do I submit my new prescription?
Order by Mail: Send your order form and the written prescription provided by your doctor to:
- Express Scripts, Inc.
- PO Box 52150
- Phoenix, AZ 85072
Order by Phone: Have your doctor call Express Scripts toll-free 877.283.3858.
Order by Fax: Have your doctor fax your order form and your written prescription to Express Scripts using the following information:
- Within the United States: Toll-Free, 877.895.1900
- Outside the United States (U.S. licensed prescribers only): 602.586.3911
Where can I get a prescription order form?
You can get an order form using any of the following options:
- Print the Mail Order Registration Form (PDF file).
- Login and print a form from the Print Forms page under Health & Benefits Information section at Express-Scripts.com/TRICARE.
- Pick up an order form at any Military Treatment Facility.
- Call Express Scripts toll-free at 877.363.1303. Select the option to leave your name and address, and we'll mail an order form to you.
Does my doctor need to write my prescription a certain way?
Have your doctor write your prescription to allow for up to a 90-day supply of medication (or the maximum days supply allowed by your benefit) with each order. Your doctor should also allow for refills for up to one year, if appropriate.
For example, if you take two pills per day, the prescription should be written to allow 180 pills with each order, indicating the prescription can be refilled three more times (for a total of one year's medication). This way, you won't have to obtain a new prescription every three months.
What information needs to be on my written prescription?The front of the prescription should include the patient's name and the other standard information provided by the doctor.
You should also provide the following information on the back of your prescription. This helps us fill your prescription safely and without delay.
- Patient's full name, including Sr. or Jr. if applicable
- Patient's address
- Patient's date of birth
- Patient's member ID number
Can I submit prescriptions written by any doctor?
By law, only prescriptions written by prescribers licensed in the United States, District of Columbia or a U.S. territory are considered valid. For controlled substances, the prescriber must provide his or her individual DEA number. Prescribers can't write prescriptions for family members.
If my doctor faxes in a new prescription, do I still have to fax/mail in the prescription order form?
No. If you wish to submit your prescription by fax, your doctor should fill out the entire order form, including your name, address and prescription information, then fax it to the Express Scripts Pharmacy. We can only receive faxed prescriptions sent directly from the doctor's office.
Can I fax in my own prescription to Express Scripts?
No. We cannot accept prescriptions faxed directly from patients. Faxes must be sent from a doctor's office and must include all of the necessary information, including the patient's first and last name, date of birth, address and member ID number. Login and print a fax form from the Print Forms page under Health & Benefits Information section at Express-Scripts.com/TRICARE so that your doctor can fill in and fax to us with the prescription.
How do I move my current prescription to a different local pharmacy?
It's easy to transfer your prescriptions to another pharmacy. Simply take your current prescription bottle to your new pharmacy and ask the pharmacist to manage the transfer from your previous pharmacy.
You can also call the new pharmacy and ask the pharmacist to contact your current pharmacy and transfer your prescription.
Or ask your doctor to call your new pharmacy with your prescription information.
When can I refill my Home Delivery prescription?
- Online Refills: To order a refill, login to Express-Scripts.com/TRICARE. Your prescriptions eligible for refill (or renewal) will be automatically displayed on the home page under the Prescriptions section. Simply click the “add to cart” button and complete the transaction.
- Refills by Mail: If you submit an order less than 90 days before the next refill date allowed by your plan, we will hold the prescription and mail you a letter informing you when we are allowed to process the refill. If you submit an order more than 90 days before the prescription renewal date, we will return the unfilled prescription with a letter informing you when it can be resubmitted, according to your plan.
What if I am told it's too early to fill my prescription?
You may refill your prescription after you have used about 66% of your medication. If you send in your refill before the allowable refill date, Express Scripts will either:
- Hold the prescription for up to 90 days and fill it on the allowable refill date, or
- Return the prescription to you if it cannot be filled within 90 days of the allowable refill date.
To avoid delays in processing, we encourage you wait to order your next refill until you have about a three-week supply left of medication left. Check your prescription bottle for your next available refill date.
When does my prescription expire?
Most prescriptions expire one year from the date they are written. The prescription cannot be filled after the expiration date, even if there are unused refills remaining.
If my prescription is NOT a compound or controlled medication, do I have to speak with a patient care advocate to order a refill?
No. While you can always order refills from a patient care advocate, you can also order refills through your online account or through Express Scripts' Integrated Voice Response system (IVR) at 877.363.1303.
My family member/caregiver handles my medications; can he/she contact Express Scripts for me and order my medication?
Yes. To protect your privacy, the person calling on your behalf must provide the sponsor's ID number, your name, date of birth, address, and telephone number. He or she should also have all of your medication bottles available to discuss your specific medications with customer service. Express Scripts will only be able to talk to your family member/caregiver about medications that you ask about by name, unless you establish power of attorney or designate them as a caregiver online via your Express Scripts Portal. Instructions to designate a caregiver online are listed below:
How to Designate a Caregiver online:
These instructions are for the beneficiary.
|If the beneficiary wants to…||Then the beneficiary should…|
|Designate a Caregiver online (Designated Caregivers can access Protected Health Information)||
Delivery & Order Status
When will I receive my prescription order?
You can expect your order to arrive at your U.S. postal address within 14 days. To make sure you receive your refills before your current supply runs out, re-order at least two weeks before you need your refill — and you may want to allow a few extra days for APO/FPO delivery.
How do I check the status of an order?
To check Order Status, login to Express-Scripts.com/TRICARE, select Manage Prescriptions and then Check Order Status for up to date information or or call toll-free, 877.363.1303. Please note, if your prescription requires additional research (for example, if a pharmacist has to contact your doctor for more information), your order may not appear on your online account until the research is completed.
What could cause my prescription order to be delayed?
On rare occasions, your order may be briefly delayed. These delays can occur for a variety of reasons, including:
- Your prescription may need prior authorization or a letter of medical necessity.
- We may be getting clarification on your eligibility or dual benefits.
- We may need your doctor to clarify your prescription.
- Your medication may be temporarily out of stock.
- Your medication may need to be shipped on ice. In this case, we need your approval for delivery time.
If a delay occurs, we will make every attempt to keep you informed.
Where will my prescription order be delivered?Your order will be mailed to any U.S. postal address, including temporary addresses, APO and FPO that we have on file for you. Orders cannot be mailed to a private foreign address.
Can I request rush shipping for my prescription order?
Yes. You will be charged $21 per order for any type of rush shipping and each family member's medications are shipped as separate orders. Therefore, if you order medications for three different family members and request rush shipping for all of those medications, your shipping costs would total $63 ($21 X 3 orders). Please note that rush shipping is not available for APO/FPO addresses.
What do I do if I have more than one address?
To add a temporary address with a start and end date or to change an address, sign in to your online account and update your information or call 877.363.1303.
What if I want to use Home Delivery, but I need to start my maintenance medications immediately?
If you need to start taking your maintenance medication right away:
- Have your doctor write two prescriptions for your medication — one for a short-term supply from a participating local pharmacy and one for a long-term supply for Home Delivery from the Express Scripts Pharmacy.
- Fill the short-term prescription immediately at a participating local pharmacy.
- Submit the long-term prescription and a prescription order form to the Express Scripts Pharmacy. You can get an order form by logging into Express-Scripts.com/TRICARE and print a form from the Print Forms page under Health & Benefits Information section.
What if I am low or out of my medication and need immediate assistance?
If you are low or out of your medication and need immediate assistance, contact us.
How do I know if my compound drug is covered?
Compounds have multiple ingredients within them and coverage is evaluated for each individual ingredient. Therefore, the best way to determine if your compound prescription is covered is to request that your pharmacist process the claim electronically. The Express Scripts system will return coverage information real-time back to your pharmacist.
Why is my compound prescription rejecting?
One or more ingredients in your prescription are not covered. Consult your pharmacist for options. You may also want to consult your prescribing physician to determine if there are other covered alternatives that could be used for your condition.
How do I request prior authorization for a compound drug?
Ask your doctor to fill out the Compound Drug Prior Authorization Form (PDF file) and submit to Express Scripts. All instructions are included on the form.
Where can I find more information on compound drug coverage?
To learn more about Compound Drugs, visit TRICARE.mil/CompoundDrugs.
Your Plan Coverage
If I meet my Catastrophic Cap requirement for the year, will I still be charged a copayment for a non-formulary medication?
No. After your cap is met, no copayments will be charged for your medications until the following fiscal year (beginning October 1).
What does it mean if my pharmacist says "prior authorization" is needed?
Prior Authorization means that additional information is needed to determine if your plan sponsor will cover the drug. It's typically reserved for high-risk or high-cost medications. If prior authorization is needed, ask your doctor to contact us.
Why isn't my prescription covered under my plan?
Your plan sponsor determines which prescription drugs are covered. Express Scripts does not decide this for you. We follow your plan sponsor's coverage guidelines and process your prescription claims accordingly.
Do some prescription drugs cost more or have additional requirements for coverage?
Yes. Some drugs are considered non-formulary or non-preferred medications and can be either brand or generic drugs. These drugs are covered at the non-formulary copayment listed above. However, your doctor can submit evidence of medical necessity for these drugs, and if the evidence of medical necessity is approved, your copayment will be reduced to the formulary (brand) copayment. The TRICARE website provides more information about medical necessity for non-formulary medications.
Other drugs are covered only if you receive prior authorization. These drugs require evidence of medical necessity by the health care provider who prescribed the medication. If the prior authorization is approved, these drugs will be covered at the formulary (brand) copayment. The TRICARE website provides more information about prior authorization requirements.
How do I pay for my prescription order?
- Online Orders: Payment by check card or credit card is the preferred method for online orders. We accept Visa, MasterCard, American Express and Discover. To order a refill or print a prescription order form using this website, provide your check card or credit card information or choose to be billed later. To add, update or change your debit or credit card select Edit Patient Information section under the Account Settings in the menu.
- Order Forms: If you are using an order form received through the mail or from your plan sponsor, we will automatically charge the debit or credit card you have on file once the order is shipped. If you do not have a card on file, you will be mailed a bill that you can pay with a debit or credit card or personal check.
What is a copayment?
A copayment is a fixed-dollar amount paid by a beneficiary for a prescription drug. The copayment cost is determined by the drug coverage guidelines of TRICARE Pharmacy Home Delivery. Copayments are the most common form of out-of-pocket expense for prescription drugs. You can use the TRICARE Formulary Search tool to learn more about your prescription costs.
How much are my copayments?
For copayment information, view your benefit details or refer to your benefit packet.
Why was I charged a non-formulary copayment for a generic drug?
Occasionally, some medications that are classified as generics may be considered non-formulary. In this case, the copayment amount depends on whether the evidence of medical necessity is approved. If the evidence of medical necessity is not approved, non-formulary generics will be subject to the non-formulary copayment. If the evidence of medical necessity is approved, non-formulary generics will be covered for the formulary (brand) copayment.
Who do I contact with billing questions?
If you have billing questions, call 877.363.1303, and a patient care advocate will be happy to assist you.
How much do I pay for each prescription?
You can use our Price a Medication feature under Manage Prescriptions in the menu to see how much you'll pay for a specific drug.
How can I change the payment information for my account?
If you have a debit or credit card on file, it will be your default payment type until it expires. You can update which debit or credit card appears as your default payment type by changing your Payment Information under the Account Settings.
What is a formulary?
A formulary is a drug list that helps determine your copayment for each prescription. In most cases, you'll pay a lower copayment for the drugs on the formulary. You can view formulary information under My Prescription Plan.
How do I find out if the drug I need is on the formulary, has a prescribing restriction or requires prior authorization?
Visit the TRICARE website to read the formulary and coverage requirements/limitations.
Why is a medication not included on the formulary?
Some medications are excluded from the in order to help control your overall healthcare costs.
What is a non-formulary or non-preferred drug?
These are drugs that are not on your formulary. In most cases, you'll pay more for these drugs.
Why is a drug not included on my formulary?
To help control your overall healthcare costs, some types of medications may not be covered by your prescription drug benefit. Examples include drugs used for cosmetic purposes such as baldness or weight loss. You will usually pay 100% of the cost of these medications at a local pharmacy.
What are generic drugs?
What are generic drugs?
A generic drug is a chemically equivalent, lower-cost version of a brand-name drug. The generic version becomes available when the brand-name drug's patent protection expires, and it usually costs about half the price of the brand-name version.
All drugs have a generic name. When a pharmaceutical company first develops a new drug, it gives the drug a generic name (or "chemical name"). The company then gives the drug a brand-name as part of its marketing plan.
What is "generic substitution"?
Generic substitution occurs when a prescription is written for a brand-name drug but is filled with a generic version.
Does TRICARE Pharmacy Home Delivery require generic substitution?
Yes. The TRICARE Pharmacy Home Delivery is a generic-based pharmacy service. Brand-name drugs for which a generic equivalent is available may be dispensed only if your doctor submits documentation of medical necessity to Express Scripts for prescribing the brand-name drug in place of its generic equivalent. All generic drugs dispensed through TRICARE Pharmacy Home Delivery meet the stringent standards of the U.S. Food and Drug Administration (FDA) for quality and therapeutic efficacy.
How can I know when a generic drug is available?
Just ask your doctor to allow for generic substitution when he or she writes your prescription. Then, if a generic is available, your pharmacist will provide it to you.
Managed healthcare programs encourage doctors to prescribe generics because they are less expensive, but some doctors (and patients) still choose higher priced brand-name drugs. Most plans charge a higher copayment for brand-name drugs than for generics. You may even pay additional costs if you request a brand name instead of its generic version.
What if my doctor prescribes a brand-name drug, but my plan requires generic substitution?
The TRICARE Pharmacy Program requires the use of generic drugs. If your doctor writes a prescription for a brand name drug and specifies that it should be dispensed as written, a pharmacist will contact your doctor and request the generic version.
Why do some generic drugs look different than their brand-name versions?
All drugs — brand-name and generic — have inactive ingredients (such as dyes, fillers and preservatives) that often determine the size, shape and color of the drug. The inactive ingredients in a brand-name drug may be different than those used in the generic versions.
If generic drugs are just as good as brand-name drugs, why do generics cost less?
Unlike the manufacturers of brand-name drugs, the makers of generics don't have to spend money on research and development, marketing, and advertising. Advertising in particular has become a huge cost of doing business, and this cost is passed along to the consumer in the form of higher priced brand-name drugs.
As for quality, the U.S. Food and Drug Administration (FDA) makes sure that generic drugs are equivalent to brand-name drugs. By equivalent, the FDA means that generics must contain the same active ingredients and work the same way in the body.
Are there reasons to stick with a brand-name drug even if there is a generic on the market?
In some cases, the generic version might not be right for you. Remember, the FDA regulates the equivalency of active ingredients in generic drugs. But there are also tiny amounts of inactive ingredients, which may give the drug its bulk or a specific shape or color. For some people these inactive ingredients may have an unanticipated effect.
For example, suppose you're allergic to wheat. If a drug has some added fiber to help it pass through the gastrointestinal system quickly, that fiber doesn't affect how the drug works on your arthritis pain. However, if the bulking agent is wheat fiber, you may experience a slight allergic reaction.
If you have a specific allergy, ask your pharmacist about the ingredients in your medicine and remind your doctor of your allergies. There are sometimes several generic versions of a drug with slightly different inactive ingredients, so there may be one that is right for you.
What about the companies that make generic drugs? Are they as trustworthy as the companies that make the brand-name drugs?
That's a common concern, but you can trust generic drug manufacturers. Many times the same company that developed the brand-name drug releases a generic version when the patent expires. Other companies specialize in making generic drugs.
Many drugs are difficult to make, even when their active ingredients are known. In fact, some drugs never become available as generics because they are too difficult or costly to make.
Why aren't all prescription drugs available in a generic version?
When a company develops a new drug and submits it for FDA approval, a 17-year patent is issued. A generic version cannot be manufactured until the 17-year patent expires.
In some cases, a drug is on the market for only a few years before the generic is available. This is usually because the original testing period required by the FDA took so many years that, by the time the drug was approved, there were only a few years left on the patent.
Other Health Insurance (OHI)
What is Other Health Insurance (OHI)?
If you have health insurance in addition to TRICARE, such as insurance through your employer or a private insurance program, it is called "other health insurance" or OHI. It is important to understand how your TRICARE pharmacy benefit works with your other insurance.
How does my TRICARE pharmacy benefit work with my other health insurance?
By law, your OHI will be the primary payer for your prescriptions, with TRICARE becoming the secondary payer.
TRICARE becomes the first payer when:
- The drug is not covered by your OHI, but is covered by TRICARE, or
- Coverage under your OHI is exhausted for the benefit year
Do I have to notify Express Scripts that I have OHI?
Yes. Full disclosure of OHI is a requirement under your TRICARE plan. It is important that Express Scripts has your current OHI information.
Please complete this form (PDF file) and follow the instructions (found in Section III) to mail the form to Express Scripts. If you have a question about the form or need assistance, please call Express Scripts at 877.363.1303.
How does my OHI work with TRICARE Pharmacy Home Delivery?
You are not eligible to use TRICARE Pharmacy Home Delivery if you have OHI with a prescription plan, including Medicare Part D prescription program, unless you meet one of the following requirements:
- Your OHI does not include pharmacy benefits
- The medication you need is not covered by your OHI
- You have met your OHI’s benefit cap (i.e., you have met your benefit’s maximum coverage limit)
What should I do if I meet one of the above three requirements?
If you meet one of these three requirements, you may submit your prescription to TRICARE Pharmacy Home Delivery. Ask your doctor or provider to write a prescription for up to a 90-day supply of medication. (Read here for details on how to get started with Home Delivery.)
Important: If your medication is not covered by your OHI or if you have met your benefit maximum, you will need to include documentation, such as a copy of an explanation of benefits (EOB) that shows your OHI did not pay. This information must be sent with your prescription for it to be filled by TRICARE Pharmacy Home Delivery.
What do I need to know about OHI and using TRICARE retail network pharmacies?
When filling a prescription at a retail network pharmacy, you should tell your pharmacist if you have TRICARE coverage in addition to your OHI. Your pharmacist will submit your prescription to both insurance plans at the same time. Letting your pharmacist know you have two prescription plans means:
- Minimal out-of-pocket expenses for you
- Never paying more than the TRICARE copayment
- No need to submit paper claims
- Reduced or eliminated up-front costs
Do supplemental and discount prescription drug programs, such as Senior Friends and AARP, count as OHI pharmacy coverage?
Should I keep my receipts to submit for reimbursement?
Yes. Once you’ve exceeded the dollar limit for your OHI or if the drug isn’t covered by your OHI, you can file a claim with TRICARE for reimbursement within one year from the date your prescription was filled. Fill out the Patient’s Request for Medical Payment (DD 2642) found on the TRICARE website here.
Submit this form along with your OHI explanation of benefits, and your receipt to:
Express Scripts, Inc. P.O. Box 52132 Phoenix, AZ 85082
Important: Both documents are necessary to process reimbursement.
What if I am a National Guard or Reserve member?
To obtain pharmacy reimbursement, National Guard and Reserve members with line-of-duty care should contact the Military Medical Support Office at 1-888-647-6676.
For help or more information, call Express Scripts at 877.363.1303 or visit tricare.mil/pharmacy/claims.
Online Account Security
Why do I need to provide personal information during the online account activation process?
To correctly identify you and your family members, Express Scripts must obtain beneficiary-specific personal information. In most cases, only you would have access to this information. These requirements help ensure the security of your health information.
Why does Express Scripts require that I keep personal information on file on its website?
We store the information you provide to ensure correct identification. We have enacted certain measures to ensure the safety of your information. However, if you prefer not to disclose your information over the Internet, you can call 877.363.1303 for assistance.
How does Express Scripts ensure that my personal information is safe and that my online transactions on its website are secure?
Your privacy and the security of your personal information are of the utmost importance to us. We will not sell or disclose your personal or health-related personal information to other companies or organizations outside of the Express Scripts company. Read our Privacy Promise for more details.
Express Scripts employs the latest security measures to ensure the security of your personal information and online transactions. For more information, read our Security Statement.
You can ensure that the environment is secured by locating the padlock icon at the bottom right-hand of your screen; in addition, the website address should start with https:// (the "s" indicates that the environment is secured).
In addition to these measures, we separate your debit or credit card information from the rest of your order data. We then store your card information on a separate server that is not accessible from the Internet to prevent external parties from viewing your information.
How do I change my e-mail address or other profile information?
To change your e-mail address, user name or password, sign into your online account and go to the Change User Name and Email under the My Account section to update your e-mail address.
Why did I receive an e-mail message from Express Scripts or one of its companies that told me to click a link or "pick up a packet" from another site?
Express Scripts and its companies often send e-mails to members that contain protected health information (PHI), such as details about your medications or health condition. These must be delivered securely to ensure your privacy. We do this by sending you an encrypted e-mail containing a unique link that will take you to the actual body of the e-mail message. This way, no PHI is transmitted directly via e-mail.
- You will not be required to download or install any software to access these e-mails. Simply click on the link to be taken to a secure website where the e-mail message is waiting.
- Encryption is done by an Internet browser (Internet Explorer, Firefox, etc).
- You will not be asked to provide confidential information to access the content of the e-mail.
What recourse do I have if it is determined that I suffer a financial loss due to someone stealing my information from Express Scripts?
While Express Scripts takes great care in trying to prevent these types of incidents, each beneficiary accepts the user agreement during registration, which indicates the extent of Express Scripts' liability. This agreement states the conditions under which the beneficiary does business with Express Scripts via the Internet. Specifically, the user agreement states that Express Scripts will do all that can reasonably be expected to protect beneficiary information; in addition, Express Scripts makes various recommendations with which beneficiaries should be familiar to help ensure privacy.
Does Express Scripts store my social security number on its systems when I register?
Express Scripts stores a copy of your member ID number when you successfully register to use this website. If your plan uses your Social Security number as your member ID number, then that number will be stored.
Your member ID number is stored on computers that reside behind several firewalls (computer programs designed to keep out intruders). In addition, our computer databases are designed to separate critical information, such as check card or credit card information and social security numbers, from less sensitive information.
Active Duty Service Members
When I place my prescription order, am I required to provide my credit card information if I am on active duty?
No, credit card information is required only for beneficiaries who are ordering online and are not on active duty, or for any beneficiary who requests rush shipping of a prescription order.
I am on Active Duty. Will I have to pay the non-formulary copayment for a non-formulary medication at Home Delivery?
Active duty service members may not fill prescriptions for a non-formulary medication unless it is determined to be medically necessary by the prescribing doctor first. Prescriptions received for non-formulary medications without evidence of medical necessity are returned to the patient. If medical necessity is approved for the active duty beneficiary, there will be no copayment ($0) charged.
If I am on Active Duty and do not wish to obtain medical necessity approval, can I pay the non-formulary copayment and obtain the non-formulary medication?
No. Under the Uniform Formulary regulations, active duty service members cannot obtain a non-formulary medication unless medical necessity is substantiated.
Deployed Service Members
How do deployed service members update their mailing address with TRICARE Pharmacy Home Delivery?
You can update your address online. Just sign in to (or activate) your online account with Express Scripts. After signing in, go to Update Address under the My Account section to update your address.
I've recently been deployed. Why can't I view the status of my refill?
When service members are deployed, they receive an initial supply of medication from a Military Treatment Facility (MTF). Their next supply is provided through TRICARE Pharmacy Home Delivery and is considered a new prescription, rather than a refill.
TRICARE Pharmacy Home Delivery automatically receives this new prescription approximately 45 days before the service member's initial supply from the MTF will run out. After the Home Delivery pharmacy receives the new prescription, status information will be visible on your Express-Scripts.com account.
National Guard and Reserve Members
Are National Guard/Reserve personnel and their families eligible?
National Guard/Reserve personnel and their family members are eligible to use TRICARE Pharmacy Home Delivery if the sponsor is on Title 10 or Title 32 (federal) active duty orders for more than 30 days. Coverage begins the day the sponsor's orders begin for both the member and his or her family members.
As a National Guard/Reserve member on Title 10 (or 32) orders for 120 days, how do I ensure coverage?
Your DEERS records must show activated status for you. To verify your eligibility status, contact DEERS before deployment, if possible, using the information below. Changes need to be made in person at the nearest ID card issuing facility.
- DMDC Support Office (DSO): 800.538.9552
- Online: www.tricare.mil/deers
Are National Guard/Reserve personnel who were on Active Duty under Title 10 and have been discharged from active duty entitled to Home Delivery and retail coverage under the TRICARE Reserve Select (TRS) Program?
These personnel are entitled to coverage if they meet the criteria for the TRS program.
What is the Uniform Formulary?
On April 1, 2004, TRICARE announced the Uniform Formulary Final rule. This rule outlines requirements for a new formulary process and copayment structure called the "Uniform Formulary" under the direction of the 2000 National Defense Authorization Act, Section 701.
As part of this new process, the DoD Pharmacy & Therapeutics (P&T) Committee, composed of pharmacists and doctors, reviews and evaluates FDA-approved prescription medications to determine their relative clinical and cost effectiveness. The committee then recommends whether a drug should be considered generic, formulary, or non-formulary.
Drugs that are equally effective but cost more compared to other drugs in the same class may be recommended for placement in the non-formulary category.
Previously, most medications were grouped into two categories: generic or brand name. Under the new process, any drug placed into the third category (non-formulary) will be available to beneficiaries at a higher copayment.
What is the copayment structure under the Uniform Formulary?
Effective Feb. 1, 2016, the copayment structure under the Uniform Formulary is as follows:
- Home Delivery (Up to a 90 day supply)
- Generic: $0
- Formulary: $20
- Non-Formulary: $49
- Retail Pharmacy (30 day supply)
- Generic: $10
- Formulary (Brand): $24
- Non-Formulary: $50
The TRICARE website provides more information on TRICARE prescription copayments.
How can I find out which drugs are considered non-formulary?
Non-formulary drugs can be found on the Non-Formulary Medications section of the TRICARE website. You can also use the TRICARE formulary tool to verify formulary status before sending in your prescription.
How can I continue paying the formulary copayment for my non-formulary medication?
If you are taking a non-formulary medication, talk with your doctor about formulary alternatives. To review therapeutic alternatives to non-formulary drugs, visit the Uniform Formulary section of the TRICARE website.
In addition, you may be able to obtain your non-formulary medication for the formulary (brand) copayment through Home Delivery or at a retail network pharmacy if your doctor provides clinical evidence that it is medically necessary for you to use the non-formulary drug instead of a formulary drug.
How do I obtain medical necessity approval?
Doctors can begin the medical necessity process by submitting a medical necessity form available on the Non-Formulary Medications section of the TRICARE website. Your doctor should then submit the form and prescription using one of the following options:
- Fax to Express Scripts toll-free at 866.684.4477 (overseas doctors use 602-586-3915)
- Mail to:
- Express Scripts
- PO Box 52150
- Phoenix, AZ 85072.
If approved, future refills of your non-formulary medication will be charged at the formulary copayment. Please note that an approval notification will not be sent to you.
Once medical necessity is established, will my approval expire?
No. After medical necessity is established, the approval will be valid for as long as you require the medication.
If I obtain medical necessity for a non-formulary drug under TRICARE Pharmacy Home Delivery, will the same override work at a retail pharmacy?
Yes. It is best to establish medical necessity under the program you will be using, however, the override will work in both the Home Delivery and the retail programs.
My prescription and medical necessity form have been sent to Express Scripts. How will I know if medical necessity approval was granted?
If the form was approved, your prescription will be processed at the formulary copayment and shipped to you. If denied, you will receive a notification letter.
You may also check the status by calling the Contact Center at 877.363.1303, which is open 24 hours a day. A patient care advocate will be happy to provide you with an update if one is available. Please allow approximately three days if faxed or seven days if mailed before calling the Contact Center.
If I previously obtained medical necessity approval for a non-formulary medication, will it be grandfathered?
Yes. If you previously obtained a medical-necessity approval before the medication was considered non-formulary, you will not be required to reestablish medical necessity under the new criteria approved by the Director of TRICARE.
Smoking Cessation Program
Who is eligible?
TRICARE beneficiaries, 18 and older and not eligible for Medicare. There are restrictions on certain drugs for some active duty service members, though other choices are unrestricted for those personnel. Home Delivery of the medications is only available to residents of the United States.
How do I get a prescription for smoking cessation drugs?
Request a prescription from your healthcare provider after discussing the best option(s) in your particular situation. Not every product is suitable for every person making a quit attempt. In this program, a prescription is required, even for the medications which are available over-the-counter.
Which medications are covered?
A variety of over-the-counter (OTC) and prescription smoking cessation medications are covered under the program. Approved medications can be found through the TRICARE Formulary Search Tool.
How many quit attempts are covered?
The TRICARE Smoking Cessation Program allows for two 120-day quit attempts during any one-year period. In certain situations, a third attempt in the same year may be offered with pre-approval. There is a limit to the number of nicotine replacement prescriptions that can be provided.
What if I get the drugs from a network retail pharmacy?
Products identified for smoking cessation, including over-the-counter (OTC) nicotine products, are only covered under the Smoking Cessation Program if obtained through TRICARE Pharmacy Home Delivery or at a military treatment facility (MTF).
I don't currently use TRICARE Pharmacy Home Delivery but would like to get started and take advantage of this program. What do I do?
To get started by placing an order, sign in to your account and use our Fill a New Prescription feature to access instructions on how you can submit your form. Here you can print out a pre-filled order form to mail along with your written prescription from your doctor, or you can print a blank order form that your doctor can fill in and fax to us with the prescription.
If I receive smoking cessation drugs through Home Delivery, can I still fill my other prescriptions at a retail pharmacy?
PDF files require Adobe Acrobat Reader.