Pharmacy and specialty pharmacy

The Defense Health Agency has been excluding some prescription drugs from TRICARE coverage after the fiscal year 2018 National Defense Authorization Act included a provision allowing DHA to do so.

Prior Authorization Forms

Certain medications require prior authorization or medical necessity. To download a prior authorization form for a non-formulary medication, please click on the appropriate link below.

Prior Authorization Forms for Non-Formulary Medications

  • Actemra (tocilizumab)
  • Addyi (filbanserin)
  • Adempas
  • Adlyxin, Byetta, Mounjaro, Ozempic, Victoza
  • Aimovig
  • Ajovy
  • Aklief (trifarotene)
  • Altoprev
  • Amitiza
  • Amzeeq (minocycline)
  • Androderm, AndroGel, Axiron, Natesto, Striant, Testim, Testosterone 1% & 1.62% gel, Vogelxo
  • Anti-Obesity Agents
  • Austedo
  • Auvi-Q
  • Baricitinib (Olumiant)
  • Basaglar (insulin glargine), Semglee (insulin glargine-YFGN)
  • Basal Insulin Analogs (Levemir and Levemir Flextouch)
  • Belsomra, Dayvigo
  • Belviq
  • Benlysta (belimumab)
  • Benzoyl Peroxide Products
  • Bepreve (bepotastine), Emadine (emedastine), Lastacaft (alcaftadine)
  • Braftovi
  • Brand Name Over Generic
  • Bremelanotide injection (Vyleesi)
  • Breo Ellipta
  • Butrans (Buphrenorphine transdermal system)
  • Bydureon, Bydureon BCise and Trulicity
  • Bystolic
  • Calquence
  • Caplyta (lumateperone)
  • Cialis (Tadalafil)
  • Cimzia (Certolizumab)
  • Compounded Medications
  • Continuous Glucose Monitor (CGM): Freestyle Libre 2 and Dexcom
  • Contrave
  • Copiktra
  • Cordran (flurandrenolide)
  • Cosentyx
  • Cotempla XR ODT (methylphenidate)
  • Cycloset (bromocriptine)
  • Cyclosporine 0.09% ophthalmic (Cequa)
  • Darolutamide (Nubeqa)
  • Denavir
  • Diclegis
  • Duexis and Vimovo
  • Duloxetine DR capsules (Drizalma Sprinkle)
  • Dupixent
  • Dutasteride (Avodart)
  • Eluxadoline (Viberzi)
  • Emgality 100mg
  • Emgality 120mg
  • Enstilar, Taclonex, Wynzora (calcipotriene-betamethasone)
  • Entrectinib (Rozlytrek)
  • Epidiolex
  • Erleada
  • Etanercept (Enbrel)
  • Eucrisa
  • Eysuvis (loteprednol)
  • Fasenra
  • Febuxostat (Uloric)
  • Fedratinib (Inrebic)
  • Ferric Maltol (Accrufer)
  • Fertility Agents (Injectable Gonadotropins Only)
  • Fetzima and Trintellix
  • Fibric Acid Derivatives
  • Firdapse
  • Fluticasone propionate 93 mcg nasal spray (Xhance)
  • Forteo
  • Fortesta (testosterone 2% topical gel)
  • Gemtesa (vibegron)
  • Gilenya (Fingolimod)
  • Gocovri (amantadine ER)
  • Gralise (gabapentin ER) and Horizant (gabapentin enacarbil ER)
  • Growth Hormone
  • Hepatitis C Medications
  • Hetlioz, Hetlioz LQ (tasimelteon)
  • H.P. Acthar Gel
  • Humira (adalimumab)
  • Ibrance
  • Ilumya
  • Imbruvica
  • Ingrezza
  • Inhaled Corticosteroids (Aerospan, Alvesco, Arnuity Ellipta, Asmanex HFA, Asmanex Twisthaler, Pulmicort Flexhaler, QVAR, QVAR Redihaler)
  • Inqovi (decitabine/ cedazuridine)
  • Intrarosa
  • Invokamet, Invokamet XR, Xigduo XR, and Segluromet
  • Invokana, Farxiga, Steglatro, and Steglujan
  • Istradefylline (Nourianz)
  • Jalyn (Dutasteride/tamsulosin)
  • Janumet (sitagliptin + metformin immediate-release) and Janumet XR (sitagliptin + metformin extended-release)
  • Januvia (sitagliptin)
  • Jornay & Azstarys
  • Jublia and Kerydin
  • Kalydeco (ivacaftor)
  • Kapspargo
  • Kazano, Jentadueto, Jentadueto XR, and Kombiglyze XR PA
  • Kerendia (finerenone)
  • Kevzara
  • Kineret (anakinra)
  • Letairis (ambrisentan), Opsumit (macitentan)
  • Levorphanol (Levo-Dromoran)
  • Linzess
  • Liptruzet
  • Livalo and Lescol XL
  • Lomaira
  • Lonhala Magnair (glycopyrrolate)‎
  • Lovaza
  • Lynparza
  • Lyrica and Lyrica CR (pregabalin)
  • Mavenclad (cladribine)
  • Mecasermin (Increlex)
  • Mekinist
  • Mektovi (binimetinib)
  • Migraine Agents: Nasal Triptans (Zomig)
  • Migraine Agents: Oral Triptans
  • Minocycline ER, Ximino ER, Coremino ER, Minolira ER, Seysara
  • Movantik
  • Mydaysis
  • Myrbetriq (mirabegron)
  • Myrbetriq Granules (mirabegron)
  • Namenda XR and Memantine ER
  • Namzaric
  • Nasal Allergy Drugs
  • Nerlynx (neratinib)
  • Neulasta, Ziextenzo, Nyvepria
  • Neupogen (filgrastim), Zarxio (filgrastim-sndz)
  • Nesina, Oseni, Tradjenta, and Onglyza
  • Newer Sedative Hypnotics (Ambien CR, Edluar, Intermezzo, Lunesta, Rozerem, Silenor, Zolpimist)
  • Newly Approved Innovator Drugs
  • Nexletol, Nexlizet
  • Ninlaro (ixazomib)
  • Nintedanib Esylate (Ofev)
  • Nocdurna
  • Noctiva
  • Nucala (mepolizumab)
  • Nucynta ER
  • Nuplazid (pimavanserin)
  • Nurtec ODT (rimegepant)
  • Ocaliva
  • Odactra
  • Omnipod and Omnipod DASH
  • Opzelura (ruxolitinib)
  • Oral Bisphosphonates (Actonel, Atelvia, Binosto, Fosamax Plus D)
  • Orencia
  • Oriahnn (elagolix/ estradiol/ norethindrone), Myfembree (relugolix/ estradiol/ norethindrone)
  • Orkambi
  • Otezla
  • Overactive Bladder Medications (Tolterodine IR/Detrol, Darifenacin/Enablex, Oxybutynin Gel/Gelnique, Oxybutynin Transdermal Patch/Oxytrol, Trospium ER/Sanctura XR, Fesoterodine/Toviaz, Solifenacin/Vesicare)
  • Oxervate
  • Pennsaid
  • Pexidartinib (Turalio)
  • Pirfenidone (Esbriet)
  • Pliaglis (lidocaine-tetracaine 7%-7%)
  • Pomalyst
  • Praluent
  • Pramlintide (Symlin)
  • Pristiq and Khedezla
  • Proton Pump Inhibitors: Nexium, Aciphex, and generics
  • Proton Pump Inhibitors: Prevacid ODT and Zegerid suspension
  • Proton Pump Inhibitors: Prevacid, Zegerid, and generics
  • Prucalopride (Motegrity)
  • Qbrexza (glycopyrronium)
  • Qsymia (phentermine/ topiramate ER)
  • Qualaquin (quinine sulfate)
  • Qudexy XR and Trokendi XR
  • Qulipta (atogepant)
  • Rapaflo (Silodosin)
  • Rayos (prednisone DR)
  • Relistor
  • Renin Angiotensin Antihypertensive Agents (RAAs)
  • Repatha (evolocumab)
  • Restasis and Ciclosporin
  • Revefenacin (Yupelri)
  • Revlimid (lenalidomide)
  • Rexulti
  • Reyvow
  • Risankizumab (Skyrizi)
  • Rocklatan and Rhopressa
  • Rytary
  • Safinamide (Xadago)
  • Savella (milnacipran)
  • Self-Monitoring Blood Glucose System (SMBGS) Glucose Test Strips
  • Semaglutide oral tablet (Rybelsus)
  • Simponi (Golimumab)
  • Skytrofa (lonapegsomatropin-tcgd)
  • Solaraze (diclofenac 3%)
  • Soliqua
  • Stelara (ustekinumab)
  • Stendra (avanafil)
  • Sulfacetamide and Sulfacetamide Sodium/Sulfur
  • Symbicort and Dulera
  • Symdeko (tezacaftor-ivacaftor)
  • Symproic
  • Synjardy and Synjardy XR
  • Tafinlar (dabrafenib)
  • Taltz
  • Tavalisse
  • Tecfidera (dimethyl fumarate)
  • Tetracyclines
  • Thiazolidinediones (TZDs, Actos, Actoplus Met, Actoplus Met XR, Duetact, Avandia, Avandament, and Avandaryl)
  • Tiopronin IR / Tiopronin DR (Thiola / Thiola EC)
  • Topical Acne and Rosacea Agents: Azelex and Finacea (azelaic acid)
  • Topical Acne and Rosacea Agents: Dapsone Products
  • Topical Acne and Rosacea Agents: Metronidazole Products
  • Topical Acne and Rosacea Agents: Retinoids and Combinations
  • Topical Acne and Rosacea Agents: Rhofade, Mirvaso and Soolantra
  • Toujeo
  • Tracleer (bosentan)
  • Tremfya (guselkumab)
  • Tresiba
  • Trikafta (elexacaftor-tezacaftor-ivacaftor)
  • Trulance (plecanatide)
  • Tymlos
  • Tyrvaya (varenicline tartrate)
  • Ubrogepant (Ubrelvy)
  • Upadacitinib (Rinvoq ER)
  • USFHP Standard PA Form
  • V-Go Disposable Insulin Delivery Device
  • Vascepa
  • Venclexta (venetoclax)
  • Verzenio
  • Viagra (Sildenafil)
  • Vytorin
  • Vyvanse
  • Vyzulta
  • Wakix (pitolisant)
  • Wegovy (semaglutide), Saxenda (liraglutide)
  • Winlevi (clascoterone)
  • Xalkori (crizotinib)
  • Xeljanz and Xeljanz XR
  • Xenical
  • Xermelo
  • Xifaxan 200mg
  • Xifaxan 550mg
  • Xiidra (lifitegrast)
  • Xolair (omalizumab) syringe
  • Xpovio (selinexor)
  • Xtandi (enzalutamide)
  • Xultophy
  • Xyosted (testosterone enanthate)
  • Xyrem (sodium oxybate)
  • Yonsa
  • Zejula (niraparib)
  • Zelboraf (vemurafenib)
  • Zembrace Symtouch
  • Zeposia (ozanimod)
  • Zerviate (cetirizine)
  • Zytiga 250 mg (abiraterone)
  • Zytiga 500 mg (abiraterone)

Pharmacy and specialty pharmacy

TRICARE beneficiaries have prescription coverage under the TRICARE pharmacy program. Express Scripts administers the TRICARE pharmacy program. If your patient is not sure if they are covered by TRICARE, they can check their eligibility TRICARE.mil/Plans/Eligibility. Beneficiaries can fill their prescriptions through home delivery, the military hospital or clinic or a retail pharmacy.

TRICARE Formulary Search Tool (FST)

The FST is a digital tool designed to educate users on medications covered under the TRICARE pharmacy benefit. When you search for your patient’s medication using the FST, you will see drug cost and fill options, any forms needed to process your patient’s prescription and coverage details.

E-Prescribe is simple and secure!

Save time by sending prescriptions electronically to your patients’ choice of a local military pharmacy, home delivery through Express Scripts or retail pharmacy!

Prior authorization may be required from Express Scripts for some medications. Please direct beneficiaries to call Express Scripts at (877) 363-1303 for questions concerning home delivery and member choice support. Learn more

E-prescribe information

Real time benefit information

Beneficiary options

Military hospital or clinic

Military hospitals and clinics on bases/posts generally have their own pharmacy and offer the least expensive prescription option. E-prescribe is an electronic prescribing capability for civilian providers to send prescription orders directly to a military hospital or clinic pharmacy.

TRICARE pharmacy home delivery

TRICARE Pharmacy Home Delivery is the preferred option for beneficiaries if the military facility pharmacy does not have the drug prescribed. All prescriptions filled through home delivery must have the prescriber’s handwritten signature.

TRICARE retail pharmacy network

TRICARE retail pharmacy network consists of approximately 60,000 retail pharmacies in the United States and most US territories including Guam, N. Mariana Islands, Puerto Rico and the US Virgin Islands. Non-network retail pharmacies may not accept TRICARE and as the most expensive option, is not recommended for beneficiaries.

Specialty pharmacy

Medex BioCare, US Bioservices and Accredo are East Region network specialty pharmacies. Specialty pharmacies are not retail pharmacy providers and much of what they offer is a part of the TRICARE medical benefit, not pharmacy benefit.

Several of the network specialty pharmacies include a “drug list or formulary”. Those pharmacies without a formulary listed expect to be contacted by the provider to determine if a particular drug/item is available to order. Beneficiaries are not allowed to contact one of the specialty pharmacies as it is for physician order only. The process includes a prescription/referral form with a fax number the provider must submit per TRICARE beneficiary, per episode of care.

Pharmacy Program

You can also complete your registration over the phone. Call 1-877-363-1296 and have your prescription bottle handy. A patient care advocate will work with your doctor to transfer your maintenance medications to Home Delivery.

Your provider will use this form to request pre-authorization to use a brand name drug instead of a generic alternative.

Your provider can email, fax or send it in the mail:

Express Scripts, Inc.
P.O. Box 52150
Phoenix, AZ 85072-2150

Medical Necessity Forms

  • Search for your drug on the TRICARE Formulary Search Tool
  • Download and print the form for your drug.
  • Give the form to your provider to complete and send back to Express Scripts.
    • Instructions are on the form
    • You don’t need to send multiple forms

    Pre-Authorization Forms

    • Search for your drug on the TRICARE Formulary Search Tool
    • Download and print the form for your drug.
    • Give the form to your provider to complete and send back to Express Scripts.
      • Instructions are on the form
      • You don’t need to send multiple forms

      Email Updates

      Sign up to receive TRICARE updates and news releases via email.

      Links to social media

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      The appearance of hyperlinks does not constitute endorsement by the DHA of non-U.S. Government sites or the information, products, or services contained therein. Although the DHA may or may not use these sites as additional distribution channels for Department of Defense information, it does not exercise editorial control over all of the information that you may find at these locations. Such hyperlinks are provided consistent with the stated purpose of this website.

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      TRICARE Expands List of Drugs It Won’t Cover

      Thousands of TRICARE beneficiaries are losing coverage for their medication as more drugs are dropped from the list of those approved for TRICARE coverage.

      The Defense Health Agency has been excluding some prescription drugs from TRICARE coverage after the fiscal year 2018 National Defense Authorization Act included a provision allowing DHA to do so.

      Previously, all medications were categorized in one of three tiers – Generic, Brand Name and Non-Formulary – with varying copays for beneficiaries.

      Has the TRICARE pharmacy Tier 4/non-covered drug issue affected your health care? Please tell MOAA about it.

      Now, drugs that DHA categorizes as “Tier 4/non-covered” are excluded from coverage under TRICARE. These Tier 4 drugs cannot be obtained at pharmacies at military treatment facilities. They also aren’t available through the TRICARE Pharmacy Home Delivery Program.

      Tier 4 drugs are only available at retail pharmacies at full out-of-pocket cost to the beneficiary. Costs for Tier 4 drugs do not apply to the annual TRICARE catastrophic cap.

      For the last year, the DHA has been identifying and reviewing drugs to potentially remove them from coverage. The first round of Tier 4/non-covered drugs was announced in August 2019 and included Glumetza, Vimovo, and Lexette. Excluding these drugs had little impact on beneficiaries since very few TRICARE patients were using these prescription drugs and alternative agents were available for them.

      However, nearly 19,000 beneficiaries taking Dexilant to treat gastroesophageal reflux disease (GERD) were impacted when that drug was dropped from TRICARE coverage effective Nov. 28, 2019.

      We also recently learned that DHA is considering adding brand-name erectile dysfunction drugs Viagra and Cialis to Tier 4/non-covered status, although this decision is pending approval from the DHA director.

      While MOAA understands the rationale for establishing Tier 4 to improve formulary management, we are concerned about where this process is headed. We are monitoring Tier 4 drug reviews closely to ensure DHA follows congressional intent and moves to Tier 4 only those medications that “provide very little to no clinical effectiveness” per the FY 2018 NDAA legislative language.

      MOAA is also pressing DHA to establish an appeals process for Tier 4 determinations.