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Pharmacy Program

TRICARE Home Delivery Pharmacy Registration Form

Use this form to register for TRICARE Pharmacy Home Delivery services. Contact your doctor to write a new prescription for up to a three-month supply with authorized refills for up to one year.

  • Complete the form
  • Attach your prescriptions to the order form-clearly write your name, sponsor ID number and date of birth on the back of the prescription.
  • Mail the New Patient Mail Order Form and your prescriptions to:

Express Scripts, Inc.
P.O. Box 52150
Phoenix, AZ 85072-2150

Your doctor can fax this form to Express-Scripts at:

  • 1-877-895-1900
  • 1-602-586-3911 (overseas)

You can also complete your registration over the phone. Call 1-877-363-1296 and have your prescription bottle handy. A patient care advocate will work with your doctor to transfer your maintenance medications to Home Delivery. 

Or, you can activate your account online.

Generic over Brand Name Prior Authorization Request

Your provider will use this form to request prior authorization to use a brand name drug instead of a generic alternative.

  • Complete the form
  • Attach the completed form to the prescription.

Your provider can email, fax or send it in the mail:

Email: TpharmPA@express-scripts.com

Fax: 1-866-684-4477

Mail the form to:

Express Scripts, Inc.
P.O. Box 52150
Phoenix, AZ 85072-2150

Medical Necessity Forms

  • Search for your drug on the TRICARE Formulary Search Tool
  • Download and print the form for your drug.
  • Give the form to your provider to complete and send back to Express Scripts.
    • Instructions are on the form
    • You don’t need to send multiple forms
  • Your medical necessity approval will apply at network pharmacies and home delivery.

Prior Authorization Forms

  • Search for your drug on the TRICARE Formulary Search Tool
  • Download and print the form for your drug.
  • Give the form to your provider to complete and send back to Express Scripts.
    • Instructions are on the form
    • You don’t need to send multiple forms
  • Your authorization approval will apply to network pharmacies and home delivery.

Last Updated 11/12/2015