Drug Tiers Explained
Generic (Formulary)
FDA-approved generic medications that are therapeutically equivalent to brand-name drugs. These are the most affordable option.
Examples: Metformin, Lisinopril, Amlodipine, Omeprazole, Sertraline
Brand Name (Formulary)
Brand-name drugs on the TRICARE formulary. Covered but at a higher copay than generics. Often used when no generic equivalent exists.
Examples: Synthroid, Crestor, Eliquis (when no generic available)
Non-Formulary
Medications not on the preferred drug list. Highest copay. Your doctor can request a formulary exception if medically necessary.
Examples: Some newer brand-name drugs, certain specialty medications
Non-Covered
Medications that TRICARE does not cover at all. You'd pay the full price out of pocket.
Examples: OTC medications (usually), cosmetic drugs, fertility drugs (some), weight loss drugs (some)
How to Look Up Your Medication
Go to the Formulary Search Tool
Visit militaryrx.express-scripts.com and navigate to the "Find a Medication" or formulary search section.
Enter Your Medication Name
Type the medication name (generic or brand). The search will show all matching results with their formulary status.
Check the Tier & Status
Look for whether the drug is listed as generic, brand formulary, non-formulary, or non-covered. This determines your copay.
Review Any Restrictions
Some formulary drugs have restrictions like prior authorization, quantity limits, or step therapy requirements. These will be noted.
What If Your Drug Is Non-Formulary?
If your medication is non-formulary, you have options. You can pay the higher copay, ask your doctor about formulary alternatives, or request a formulary exception:
Formulary Exception Process
- 1Your doctor determines the formulary medication isn't appropriate for you
- 2Your doctor contacts Express Scripts (or your regional contractor) with medical justification
- 3Express Scripts reviews the clinical documentation
- 4If approved, you'll pay the brand-name copay instead of non-formulary
- 5If denied, you can appeal the decision through TRICARE's appeals process
Money-Saving Tip: Always ask your doctor if a generic alternative exists. Generic medications are just as effective and can save you $14-68 per fill compared to brand or non-formulary drugs.
Common Questions
What is a formulary?
A formulary is the list of medications that TRICARE covers. Drugs are organized into tiers (generic, brand, non-formulary) that determine how much you pay. The formulary is managed by the Department of Defense Pharmacy and Therapeutics Committee.
Does the formulary change?
Yes. The TRICARE formulary is updated quarterly. Medications can be added, moved between tiers, or removed. Express Scripts sends notifications when your medications are affected by formulary changes.
What does "prior authorization" mean?
Some medications require your doctor to get approval from TRICARE before the prescription can be filled. This ensures the medication is medically necessary and appropriate. Your doctor handles the authorization process.
What is "step therapy"?
Step therapy means TRICARE requires you to try a less expensive medication first (usually a generic) before covering a more expensive alternative. If the first medication doesn't work, your doctor can then prescribe the next option.
Can I get a non-formulary drug covered at a lower cost?
Yes, through a formulary exception. Your doctor submits medical justification explaining why you need that specific drug. If approved, you pay the brand-name formulary copay instead of the higher non-formulary rate.
Are over-the-counter (OTC) drugs covered?
Generally no. Most OTC medications are not covered by TRICARE. However, some OTC drugs may be covered when prescribed by a doctor (such as certain allergy medications or acid reflux drugs). Your MTF pharmacy may stock some OTC items.