Pharmacy Program

TRICARE Pharmacy Home Delivery Form

TRICARE Pharmacy Home Delivery Order Form

Use this form to sign up for TRICARE Pharmacy Home Delivery services. Contact your doctor to write a new prescription for up to a three-month supply with authorized refills for up to one year.

• 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.
• Mail the form and your prescriptions to:

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

Your doctor 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. 

Or, you can activate your account online.

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.

• Complete the form.
• Attach the completed form to the prescription.

Your provider can email, fax, or send it in the mail:

Email: TpharmPA@express-scripts.com

Fax: 866-684-4477

Mail:

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

Medical Necessity Forms

• 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.
  • Instructions are on the form.
  • You don’t need to send multiple forms.
• Your medical necessity approval will apply at network pharmacies and home delivery.

Prior Authorization Forms

• 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.
  • Instructions are on the form.
  • You don’t need to send multiple forms.
• Your authorization approval will apply to network pharmacies and home delivery.