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Get Medical Necessity for Non-Formulary Drugs

You can get the non-formulary drug at a retail network pharmacy or home delivery for the lower "formulary" cost share (or at no cost for active duty) if you can establish medical necessity:

  1. Search the chart for medical necessity criteria and forms. All drugs are listed by therapeutic class, brand name, and generic name.
  2. Download and print your drug's medical necessity form.
  3. Give the form to your provider to complete.
  4. Follow the instructions on the form to deliver it to Express Scripts. You do not need to submit multiple forms because medical necessity approvals apply to both the home delivery and retail network pharmacy options.

If you can't find the form you need, send a message to DOD.customer.relations@express-scripts.com with your information and Express Scripts will contact you.

Search the TRICARE Formulary to learn more about specific drugs, copayments, and common drug interactions, or to check for generic equivalents or determine if a drug is considered a non-formulary medication.

Search the TRICARE Formulary Button

Last Updated 12/5/2013

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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