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Resources for Providers

TRICARE Pharmacy Benefit: Four Points of Service for Beneficiaries

The TRICARE Pharmacy Program provides outpatient prescription drugs through four outpatient service options:

Military Pharmacies (Military Treatment Facilities)

  • Basic Core Formulary drugs
  • Many brand-name maintenance drugs on the Uniform Formulary
  • Up to a 90-day supply of most medications
  • Non-formulary medications are generally not available at military pharmacies

More information:

TRICARE Pharmacy Home Delivery

With this option, beneficiaries can enjoy the convenience, safety & savings of receiving their medications delivered right to their home. TRICARE Pharmacy Home Delivery, serviced by Express Scripts, is recommended for maintenance medications and is the beneficiary's least expensive option when not using a military pharmacy. Some benefits include:

  • Up to a 90-day supply for most drugs
  • Standard shipping at no additional cost to the beneficiary
  • Option for Automatic refills
  • Medications shipped to the beneficiary's home safely in a secure, weather-resistant pouch
  • Medications requiring temperature controls are delivered safely. Using innovative technology, medications are shipped in temperature-protective coolers with warming gel packs during frigid temperatures.

More information:

Network Retail Pharmacies

  • One copayment for each 30-day supply
  • No need to submit a claim
  • Access to a network of approximately 57,000 TRICARE retail network pharmacies in the U.S. and U.S. territories
  • To find the nearest TRICARE retail network pharmacy, visit www.express-scripts.com/TRICARE or call 877.363.1303
  • Note: Some non-formulary drugs are only covered through Home Delivery. Beneficiaries should check with Express Scripts before filling prescriptions for non-formulary drugs at a TRICARE retail network pharmacy.

More information:

Non-Network Pharmacies

  • Most expensive option
  • Beneficiary pays the full price of their medication up front and files a claim for reimbursement
  • Reimbursements are subject to deductibles, out-of-network cost-shares, and TRICARE-required copayments

More information:

MTF Pharmacy Help Desk

For assistance or questions about the TRICARE pharmacy benefit, contact the MTF Pharmacy Help Desk. Providers can reach the Help Desk at the following numbers:

  • Provider Prescription Call-In: 877.283.3858
  • Provider Prior Authorization: 866.684.4488

Electronic Prescribing

The Electronic Prescribing (eRx) initiative allows civilian providers to electronically transmit prescriptions to military pharmacies. ePrescribing reduces prescribing errors and makes the prescription process easier and more efficient for both you and the beneficiary.

When you choose ePrescribing, the beneficiary will get the most cost-effective medication. The secure ePrescribing network sends the prescription safely and quickly to the pharmacy of the beneficiary's choice.

How ePrescribing Works:

  1. Enter patient's information into the ePrescribing application
  2. Select the "TRICARE" formulary to view medications covered by the TRICARE pharmacy benefit
  3. Send the prescription directly to TRICARE Pharmacy Home Delivery — by selecting "Express Scripts Mail Pharmacy" — or a network retail pharmacy of the beneficiary's choice. It's that simple.

More information:

Prescription Monitoring Program (PMP)

The PMP is designed to identify potential unsafe behavior with regard to controlled medications and prevent or decrease the risk of overutilization by restriction implementation. Beneficiary enrollment can be requested by the Military Treatment Facility (MTF) or the TRICARE Managed Care Support Contractor (MCSC).

Express Scripts (ESI) identifies candidates for enrollment on a quarterly basis using pre-determined criteria, including utilization patterns of controlled substances and/or other high risk medications. Identified beneficiaries are sent to the assigned MTF or the respective TRICARE MCSC to review prescription history in conjunction with medical history to determine enrollment. Identification can also occur internally by the MTF or the TRICARE MCSC.

Additional information and the MTF restriction request form can be found at: https://www.express-scripts.com/TRICARE/tools/rxMonitoring.shtml.

Specialty Medication Care Management Program

Express Scripts has resources to help patients taking specialty medications manage their conditions. TRICARE beneficiaries who are taking a specialty medication and are enrolled in TRICARE Pharmacy Home Delivery receive additional benefits from the Specialty Medication Care Management Program, including:

  • Access to nurses and pharmacists, and social workers specializing in complex disease states
  • Specialty patient care advocates to answer questions and process medication requests
  • Scheduled medication deliveries to the patient’s specific location
  • Refill reminder calls to help the patient stay adherent
  • Nurses will contact the patient’s provider to discuss any side effects and/or changes in condition as reported by the patient during scheduled phone calls
  • Specialty consultations with a nurse or pharmacist at any point during your therapy

Express Scripts also offers the following services to beneficiaries with certain chronic diseases (such as multiple sclerosis, rheumatoid arthritis, hepatitis C and psoriasis):

  • Nurse outreach with scheduled phone assessments
  • Proactive, structured clinical assessments
  • Comprehensive patient education for disease and drug therapy
  • Help to achieve the best drug utilization and adherence

More information:

Formulary Search Tool

Providers, pharmacists and beneficiaries can use the Express Scripts TRICARE Formulary Search Tool to obtain helpful information about drug coverage, including:

  • Whether a drug is designated formulary or non-formulary
  • Copayment amounts for drugs at each point of service, including Home Delivery
  • Generic equivalent information for brand name medications
  • Prior authorization or medical necessity information, if needed, including links to necessary forms

Prior Authorization

For prescriptions that require a prior authorization or medical necessity review, forms are available on the Formulary Search Tool. Beneficiaries and providers can download and print the necessary forms and submit them to Express Scripts.

More information:

Deployment Prescription Program

Resources are available for TRICARE beneficiaries preparing to deploy which allow them to obtain prescription medications while in theater. Through the Express Scripts Deployment Prescription Program, in-theater beneficiaries can receive their medications through TRICARE Pharmacy Home Delivery.

For questions about the Deployment Prescription Program, contact the Deployment Account Management team:

  • Email: DeployedPrescriptionProgram@express-scripts.com
  • Phone: 855.215.4488 or 314.684.7506 between the hours of 8am — 8pm CST Monday through Friday If you are calling after hours, leave a voice mail with your name, reason for your call and the best way to contact you. Express Scripts will return your call or send you an email.

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