Non-Formulary

Non-formulary medications are prescription drugs that are not included on TRICARE's preferred drug list (formulary). These medications are still covered by TRICARE but carry the highest copayment tier, making them significantly more expensive for beneficiaries.

Non-formulary drug costs (2024): • Military pharmacy: $0 (when available) • Home delivery (90-day supply): $29 • Retail pharmacy (30-day supply): $33 • Non-network pharmacy: You pay full cost, then file for partial reimbursement

Requirements for non-formulary drugs: • Prior authorization is required when filled through home delivery or retail pharmacies • Your provider must document medical necessity • Generic or formulary alternatives must typically be tried first • MTF pharmacies may stock some non-formulary drugs at no cost

When non-formulary drugs may be appropriate: • Formulary alternatives have been tried and failed • Medical condition requires a specific medication • Provider documents clinical reasons for the non-formulary choice

Talk to your provider about formulary alternatives that may be equally effective at lower cost. The Express Scripts formulary search tool can help identify covered alternatives.