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TRICARE Formulary

View questions and answers about the TRICARE Formulary.

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TRICARE Formulary
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: 

DHA Address: 7700 Arlington Boulevard | Suite 5101 | Falls Church, VA | 22042-5101

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