TRICARE, Your Military Health Plan

In This Section:

• Formulary & Non-Formulary Medications
• DoD Pharmacy and Therapeutics Committee
• Beneficiary Advisory Panel
• Medical Necessity for Non-formulary Medications
• Generic Medications
• Vaccines
• Step Therapy
• Home Infusion Therapy
• Prior Authorization
• Quantity Limits
• Specialty Medications
• Filling Specialty Medication Prescriptions
• Expert Assistance Available
• Injectable Medications
• Over the Counter Medications Demonstration Project
• Medications Not Covered by TRICARE

Formulary & Non-Formulary Medications

In 2005, the Department of Defense (DoD) established a uniform formulary, which is a list of covered drugs consisting of generic and brand-name drugs. This formulary also contains a third tier of medications that are designated as "non-formulary." Prescriptions for non-formulary drugs can be dispensed, but at a higher cost to beneficiaries, unless the provider can establish medical necessity.

Since 2005, there have been multiple therapeutic classes of medications reviewed by the DoD Pharmacy and Therapeutics (P&T) Committee for classification of pharmaceuticals into the three-tier structure. A therapeutic "class" is a grouping of medications used for the same medical condition. The uniform formulary is available worldwide at DoD's three points of pharmacy service (MTFs, retail network pharmacies, and through home delivery).

The DoD P&T Committee is charged with reviewing and recommending medications to be moved to the third tier of the uniform formulary. These recommendations are presented to the Beneficiary Advisory Panel (BAP) for comment during a public meeting. The recommendations and comments are then presented to the Director, TRICARE Management Activity for approval. The DoD P&T Committee meets quarterly to review medications in selected therapeutic classes for relative clinical and cost-effectiveness. The committee also considers safety and patient tolerability.

At the end of the process, the prescription will be either classified as formulary or non-formulary. The formulary classification is also divided into formulary-generic and formulary-brand name. These classifications combined with where the prescription is filled determines your out-of-pocket costs. >>Learn More About Pharmacy Costs

What is the Basic Core Formulary (BCF)?

Last Modified:January 30, 2012