TRICARE, Your Military Health Plan

Claims

If you have your prescription filled at a non-network pharmacy or if you have other health insurance with a prescription drug plan, you will need to submit a claim for reimbursement.

Prescription claims must be filed within one year of the date of service.  To file a pharmacy claim, fill out a Patient's Request for Medical Payment (DD Form 2642) and include the following information with your claim. It is highly recommended that you submit an explanation of benefits (EOB) if you are filing a pharmacy claim when you have other health insurance (OHI).

The following information is required and cannot be handwritten on the EOB or the pharmacy printout:

• Date of fill
• Quantity
• Pharmacy name
• What you (the beneficiary) paid
• Drug name and strength

The following information is required and may be handwritten on the EOB or receipt:

• Number of day's supply
• Prescription number
• Pharmacy address
• Doctor's name or DEA number
• Pharmacist's signature (for retail pharmacy claims only; pharmacist signature not required for home delivery claims)
• Amount paid by the OHI or the retail price from the pharmacy

Claims Filing Addresses
In the U.S. or a U.S. Territory, file your claim with the pharmacy contractor:

Express Scripts
P.O. Box 52132
Phoenix, AZ 85072

In an overseas area (other than a U.S. Territory), file your claims with the overseas claims processor, at the appropriate address.

Enrolled in the US Family Health Plan?

Last Modified: September 10, 2012