Non-Formulary Drugs

If a drug you're prescribed is identified as non-formularyAny drug in a therapeutic class determined to not be as clinically-effective or as cost-effective as other drugs in the same class., you can find a list of alternative formulary drugs and a link to the medical necessity criteria and forms in the TRICARE Formulary.

Search the TRICARE Formulary Button

You can fill prescriptions for non-formulary drugs through home delivery or at most network pharmacies at a higher cost. If your provider can establish medical necessity, you can get it filled for the lower "formulary" cost share (or at no cost for active duty). >>View Costs

Get Medical Necessity

  1. Search the chart with medical necessity criteria and forms. We list the drugs by therapeutic class, brand name, and generic name.
  2. Download and print the form for your prescription drug.
  3. Give the form to your provider to complete.
  4. Send the form to Express Scripts.
    • Follow the instructions on the completed form.
    • You don’t need to submit multiple forms. 
    • Your medical necessity approval will apply at network pharmacies and home delivery.

Can't Find a Form?

Non-Formulary Prescriptions at Military Pharmacies

You can fill your prescription for a non-formulary drug at a military pharmacy ONLY IF:

  • Written by a provider at that military hospital or clinic, and
  • Medical necessity is established. 

Military pharmacies aren’t required to fill a prescription for a non-formulary drug written by a civilian provider, but MAY do so IF:

  • You were referred to the civilian provider, and
  • Medical necessity is established.

Last Updated 5/6/2014

contact Your Contacts
Express Scripts, Inc.

Stateside: 1-877-363-1303
Overseas: 1-866-275-4732
(where toll-free service is established)

www.express-scripts.com/tricare


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