Pharmacy Program

TRICARE Pharmacy Home Delivery Form

You can switch your medications to TRICARE Pharmacy Home Delivery online or through the Express Scripts Pharmacy mobile app.

Learn more about home delivery

You can also submit the TRICARE Pharmacy Home Delivery Order Form by mail.

• Download and complete the form.
• Attach your prescriptions to the order form. Clearly write your name, sponsor ID number, and date of birth on the back of the prescription.

If submitting by mail, include your written prescription and copayment. You can find your copayment using the TRICARE Formulary Search Tool. 

Mail the form and your prescriptions to:

Express Scripts, Inc.
P.O. Box 52150
Phoenix, AZ 85072-2150

Your provider can fax this form to Express Scripts at:

• 877-895-1900
• 602-586-3911 (overseas)

You can also complete your registration by phone. Call 877-363-1303 and have your prescription bottle handy. A patient care advocate will work with your doctor to transfer your maintenance medications to home delivery. 

Prior Authorization for Brand-Name Drugs

Brand Name Over Generic Prior Authorization Request

Your provider will use this form to request prior authorization to use a brand-name drug instead of a generic alternative.

Your provider can submit an electronic prior authorization, which is the fastest option. Email, fax, or mail submission are also available.

To submit via email, fax, or mail:

• Download and print the form for your drug on the TRICARE Formulary Search Tool.
• Give the form to your provider to complete and send back to Express Scripts.
  • Instructions are on the form.
  • You don't need to send multiple forms.

Email: TpharmPA@express-scripts.com

Fax: 866-684-4477

Mail:

Express Scripts, Inc.
P.O. Box 52150
Phoenix, AZ 85072-9954