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What is the TRICARE formulary?
Verified by TRICARE.com Editorial Team
Updated 2024-12-01
AI-assisted (gemini, gpt-4o)
Quick Answer
The TRICARE formulary is the list of covered medications in tiers: generic (lowest cost), brand formulary (moderate), non-formulary (highest). Check at Express Scripts or TRICARE.mil.
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Key Takeaways
- Formulary determines costs
- Generics are cheapest
- Some drugs need prior auth
- Check before filling
Detailed Answer
Understanding the TRICARE formulary:
What It Is
- Official list of covered medications
- Managed by DoD Pharmacy & Therapeutics Committee
- Updated regularly
- Organized into cost tiers
Formulary Tiers
- Generic: Lowest cost
- Brand formulary: Moderate cost
- Non-formulary: Highest cost
- Specialty: Special handling
Why Formulary Matters
- Determines your copay
- Affects which pharmacy can fill
- Some drugs require prior authorization
- Generic alternatives may be required
Checking the Formulary
- Express Scripts website
- TRICARE.mil formulary search
- Call Express Scripts
- Ask your pharmacist
Prior Authorization
- Some drugs need approval
- Provider submits request
- Medical necessity review
- Alternative may be suggested
Non-Formulary Options
- Higher out-of-pocket cost
- May still be covered
- Provider can request exception
Helpful Tips
- Search formulary before new prescriptions
- Ask about generic alternatives
- Request exceptions if needed
Related TRICARE Terms
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