Prescription Coverage

Prescription coverage under TRICARE provides beneficiaries with access to prescription medications through multiple channels, including military pharmacies, home delivery, and retail pharmacies. The TRICARE pharmacy benefit is managed by Express Scripts and offers varying costs depending on the medication tier and fill location.

Prescription fill options and costs: • Military pharmacy: $0 for all covered medications • Home delivery (90-day supply): $0 generic, $29 brand formulary, $65 non-formulary • Retail pharmacy (30-day supply): $14 generic, $38 brand formulary, $65 non-formulary • Non-network retail: Pay full cost, file for reimbursement

Formulary tier system: • Generic: Lowest cost, preferred generic medications • Brand-name formulary: Moderate cost, preferred brand drugs • Non-formulary: Highest cost, requires prior authorization at retail/home delivery • Non-covered: Not covered by TRICARE pharmacy benefit

Managing prescription costs: • Use military pharmacies whenever available for $0 copays • Switch to home delivery for maintenance medications • Ask about generic alternatives • Check the formulary before starting new medications • Use the Express Scripts drug pricing tool

Special prescription programs: • Specialty pharmacy for high-cost medications • Compound medications (with restrictions) • Vaccine coverage through pharmacies • Smoking cessation medications

Keep your DEERS information current and carry your military ID to ensure smooth prescription processing at all pharmacy locations.