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TRICARE Formulary

The TRICARE Uniform Formulary (UF) is a list of brand name and generic drugs and supplies that TRICARE covers. 

You can search the TRICARE Formulary to:

  • Look up costs, quantity limits and therapeutic alternatives
  • Download medical necessity or prior authorization forms
  • See if your prescription is on the Basic Core FormularyThe Basic Core Formulary (BCF) is a list of medications required to be on formulary at all full-service military treatment facilities (MTFs). BCF medications are intended to meet the majority of the primary care needs of DoD beneficiaries.Basic Core Formulary or Extended Core FormularyThe Extended Core Formulary (ECF) includes medications in therapeutic classes that are used to support more specialized scopes of practice than those on the Basic Core Formulary (BCF).Extended Core Formulary. 

Search the TRICARE Formulary

A non-formulary drug can be provided at the formulary cost share if your provider supplies information showing that there is a medical necessity to use the non-formulary drug instead of a therapeutic alternative. 

Frequently Asked Questions

Q1:

Is my medication covered by TRICARE?

A:

You can find out if your medication is covered by looking it up on the Formulary Search Tool.

Q2:

What can I do if my medication isn't covered?

A:

Your provider can call the Express-Scripts Prior Authorization line @ 1-866-684-4488 to request a medical necessity override. 

NOTE: In some cases your medication (injections and vaccines) may be covered as a medical benefit so you can call your TRICARE Regional Contractor.

Q3:

What can I do if my medical necessity override for a non-covered medication is not approved?

A:

You can contact Express-Scripts Customer Service @ 1-877-363-1303 for information regarding the appeals process.

Q4:

How do I know if generic is required for my medication?

A:

You can find out if generic is required by looking it up on the Formulary Search Tool.

Q5:

How do I get a brand name instead of generic?

A:

Your provider can either call the Express-Scripts prior authorization line @ 1-866-684-4488 to establish medical necessity or he/she can fill out the Brand over Generic Prior Authorization Request Form and fax it to Express-Scripts.

Q6:

What can I do if the request for brand name was denied?

A:

You can contact Express-Scripts Customer Service @ 1-877-363-1303 for information regarding the appeals process.

Q7:

How do I know if my medication requires prior authorization?

A:

You can find out if your medication requires prior authorization by looking it up on the Formulary Search Tool.

Q8:

What if my medication requires prior authorization?

A:

Your provider can either call the Express-Scripts prior authorization line @ 1-866-684-4488 or he/she can fill out the prior auth form that is linked to that medication on the Formulary Search Tool and fax it to Express-Scripts.

Q9:

What can I do if my prior authorization was denied?

A:

You can contact Express-Scripts Customer Service @ 1-877-363-1303 for information regarding the appeals process.

Q10:

How do I know if my medication requires medical necessity?

A:

You can find out if your medication requires medical necessity by looking it up on the Formulary Search Tool.

Q11:

What if my medication requires medical necessity?

A:

Your provider can either call the Express-Scripts prior authorization line @ 1-866-684-4488 to establish medical necessity or he/she can fill out the medical necessity form that is linked to that medication on the Formulary Search Tool and fax it to Express-Scripts.

Q12:

What can I do if my medical necessity was denied?

A:

You can contact Express-Scripts Customer Service @ 1-877-363-1303 for information regarding the appeals process.

Q13:

Is there an age restriction on my medication?

A:

You can look up your medication on the Formulary Search Tool. These will be listed under the "Notes" section.

Q14:

How do I get my medication if there is an age restriction?

A:

Your provider will need to call the Express-Scripts Prior Authorization line @ 1-866-684-4488 to establish medical necessity.

Q15:

What can I do if the request for a medical necessity override was denied?

A:

You can contact Express-Scripts Customer Service @ 1-877-363-1303 for information regarding the appeals process.

Q16:

Are there quantity limits on my medication?

A:

You can find out if there are quantity limits on your medication is covered by looking it up on the Formulary Search Tool. These will be listed under the "Notes" section.

Q17:

What can I do if my doctor wants me to take more than the allowed amount

A:

Your provider can call the Express-Scripts PA line @ 1-866-684-4488 to establish medical necessity for a quantity limit override.

Q18:

What can I do if the request for a quantity limit override was denied?

A:

You can contact Express-Scripts Customer Service @ 1-877-363-1303 for information regarding the appeals process.

Q19:

How can I get reimbursement for a prescription if I paid full price or my other health insurance (OHI) cost share?

A:

You can contact Express-Scripts Customer Service @ 1-877-363-1303 for assistance.

Q20:

How can access more information about my medication like indications and side effects?

A:

The following websites have medication information like indications and side effects: 

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Request for DoD P&T Committee Consideration of Potential Changes to the Uniform Formulary, Basic Core Formulary or Extended Core Formulary

Form/Template
1/28/2016

Please attach MTF P&T Committee comments & meeting minutes, an explanation of the rationale for the request, copies of supporting clinical evidence, and anything else that needs to be considered by the DoD P&T Committee.

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TRICARE Formulary

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7/28/2015
Formulary Process

Watch this episode of TRICARE TV to learn about the TRICARE Pharmacy Formulary Process.

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Military Health System Prescription Transfer Procedures

Policy

Effective immediately, all Department of Defense (DoD) military treatment facility (MTF) outpatient phannacics will accept patient requests for prescription transfers from another MTF and from retail phannacies. When another phannacy requests prescription transfer infonnation on behalf ofa patient, DoD MTF outpatient phannacies will respond to the inquirer in a timely maru1er.

TRICARE Pharmacy Benefit Program Formulary Management Clarification

Policy

Questions have arisen concerning the requirement for military treatment facilities (MTFs) to provide medications prescribed by MTF providers. This requirement has commonly been referred to as the "You write it, you fill it" policy.

  • Identification #: HA Policy 04-032
  • Date: 3/22/2005
  • Type: Memorandums
  • Topics: TRICARE Formulary

TRICARE Pharmacy Benefit Program Formulary Management

Policy

The Department ofDefense was directed to establish an effective, efficient, integrated pharmacy benefits program for the Military Health System, to include a Uniform Formulary of pharmaceutical agents.

  • Identification #: HA Policy: 04-032
  • Date: 12/22/2004
  • Type: Memorandums
  • Topics: TRICARE Formulary
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Showing results 1 - 5 Page 1 of 1

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