Non-Formulary Drugs

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. are covered with a higher cost-shareA percentage of the total cost of a covered health care service that you pay. than drugs in the generic formulary or brand-name formulary categories. View pharmacy costs.

• Some non-formulary drugs are only covered through TRICARE Pharmacy Home Delivery.
• If your provider can establish medical necessity, you can get the non-formulary drugs at the formulary cost-share (or at no cost for active duty service members).  

How to Get Medical Necessity for Non-Formulary Drugs

• Search for your drug on the TRICARE Formulary Search Tool.
• Download and print the form for your drug.
• Give the form to your provider to complete and send back to Express Scripts, the TRICARE Pharmacy Program administrator.
  • Instructions are on the form.
  • You don’t need to send multiple forms.
• Your medical necessity approval will apply at network pharmacies and TRICARE Pharmacy Home Delivery.

Can't Find a Form?

• Send a message to DOD.customer.relations@express-scripts.com.
• Express Scripts will contact you.