Get Prior Authorization or Medical Necessity

Prior Authorization

Prior authorization is a routine process.  We use it to make sure your prescription drug is:

• Safe
• Effective
• Medically necessaryTo be medically necessary means it is appropriate, reasonable, and adequate for your condition.
• Cost effective

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.   

How to Get Prior Authorization

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 military pharmacies, network pharmacies, and home delivery.

Can't find the form you need? Contact Express Scripts.

How to Get Medical Necessity

• 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.

Can't find the form you need? Contact Express Scripts.

You can search the TRICARE Formulary to learn more about specific drugs, copayments, and common drug interactions, or to check for generic equivalents or determine if a drug is considered a non-formulary medication.