Pharmacy Claims

When should I file a claim?

You’ll need to file a claim for reimbursement if:

• You get your prescription filled at a non-network pharmacy. Reimbursements are subject to applicable deductibles, cost-shares, and copayments.
• You have other health insuranceHealth insurance you have in addition to TRICARE, such as Medicare or an employer-sponsored health insurance. TRICARE supplements don’t qualify as "other health insurance." with pharmacy benefits.

You must file your claim within one year of the date of service.

How can I file a claim?

You may be able to file a claim online or by mail.

Required Information With Your Online Claim

To file your claim file a claim online, you’ll need:

• An Express Scripts account
• Your prescriber’s information
• A photocopy of your pharmacy receipt
• Your pharmacy’s phone number

Required Information With Your Claim

• Fill out a Patient’s Request for Medical Payment form (DD Form 2642).
• You must send the form and the information below with your claim.
• If you have other health insurance, you should send an explanation of benefits.

CAN’T Be Handwritten on the EOB or Pharmacy Receipt	CAN Be Handwritten on the EOB or Pharmacy Receipt
Date of fill Quantity Pharmacy name What you (the beneficiary) paid Drug name and strength	Number of days’ supply Prescription number Pharmacy address Doctor’s name or DEA number Pharmacist’s signature (for retail pharmacy claims only) Amount paid by other health insurance or the retail price from the pharmacy

Claims Filing Addresses

In the U.S. or a U.S. territory, file your claim with the pharmacy contractor:

Express Scripts, Inc.
P.O. Box 52132
Phoenix, AZ 85082

In an overseas area (other than a U.S. territory), you’ll file your claim with the overseas claims processor. File a claim through the overseas secure claims portal or at the appropriate address.

Active Duty Claims for All Overseas Areas	TRICARE Active Duty Claims P.O. Box 7968 Madison, WI 53707-7968
Eurasia-Africa Non-Active Duty Claims	TRICARE Overseas Program P.O. Box 8976 Madison, WI 53708-8976
Latin America & Canada Non-Active Duty Claims	TRICARE Overseas Program P.O. Box 7985 Madison, WI 53707-7985
Pacific Non-Active Duty Claims	TRICARE Overseas Program P.O. Box 7985 Madison, WI 53707-7985