Prescription Drugs

TRICARE provides prescription drug coverage with most TRICARE health plans. If you use the US Family Health Plan, you have a separate pharmacy coverage.

TRICARE Formulary

The TRICARE Formulary is a list of generic and brand-name prescription drugs that we cover. TRICARE covers most prescription drugs approved by the U.S. Food and Drug Administration. Prescription drugs may be covered under the TRICARE pharmacy benefit or the medical benefit.

We review and update the TRICARE Formulary each quarter. After each review, some drugs may move from one category to another. You’ll get a letter from Express Scripts, the TRICARE Pharmacy Program contractor, if you have a prescription for a formulary drug that’s changing to a non-formulary drug.

Search the TRICARE Formulary.

Covered and Non-Covered Drugs

Your costs will vary depending on your drug category. Prescription drugs fall into four categories:

1. Generic formulary drugs
2. Brand-name formulary drugs
3. Non-formulary drugsA drug in a therapeutic class that isn’t as clinically or cost-effective as other drugs in the same class. You pay a higher cost share for these drugs.
4. Non-covered drugs

These categories follow industry standards. They depend on the medical effectiveness and cost effectiveness of a drug compared to other similar drugs.

Prior Authorization Requirements

Certain prescriptions require prior authorization. You may need prior authorization for your prescription if it:

• Is specified by the DOD Pharmacy & Therapeutics Committee
• Is a brand-name prescription drug with a generic substitute
• Has age limits
• Is prescribed for an amount more than the normal limit

Check the TRICARE Formulary to see if you need prior authorization.

Prescription Drugs

There are specific rules for filling prescriptions for certain types of drugs. Learn more about filling prescriptions for these drugs:

• Compound drugs
• Certain maintenance drugs
• Specialty drugs