TRICARE pharmacy program
Effective October 1, 2015 all TRICARE beneficiaries with the exception of Active Duty Service Members, must obtain select “brand name maintenance drugs” through either their military pharmacy or through the TRICARE Pharmacy Home Delivery Program.
TRICARE beneficiaries have the following options for filling prescriptions:
- Military hospitals and clinics on bases/posts generally have their own pharmacy and offer the least expensive option for TRICARE and the beneficiary (no copay or cost share) to fill prescriptions. However, many formularies vary. The beneficiary can verify availability. E-prescribe is an electronic prescribing capability for civilian providers to send prescription orders directly to a military hospital or clinic pharmacy. Learn more
- TRICARE pharmacy home delivery is the preferred option for beneficiaries if the military hospital or clinic pharmacy does not have the particular drug prescribed available. All prescriptions filled through home delivery must have the prescriber’s handwritten signature. Member Choice Centers help TRICARE beneficiaries to transfer their current military pharmacy or retail pharmacy maintenance medication prescriptions to home delivery.
- TRICARE retail pharmacy network consists of approximately 60,000 retail pharmacies in the United States and most U.S. territories including-(Guam, N. Mariana Islands, Puerto Rico, and the U.S. Virgin Islands)
- Non-network retail pharmacies may not accept TRICARE and as the most expensive option, is not recommended for beneficiaries.
Generic Drug Policy is a TRICARE policy to promote use of generic medications instead of brand-name medications whenever possible.
Prior authorization may be required from Express Scripts for some medications. Medications requiring prior authorization may include prescription drugs specified by the TRICARE Pharmacy Program, brand-name medications with a generic equivalent, medications with age limits, and medications prescribed for quantities exceeding normal limits. Learn more
Please direct beneficiaries to call Express Scripts at 1-877-363-1303 for questions concerning home delivery and member choice support. Visit online
Specialty pharmacy information
Network and Provider Solutions offers the above listed Network Specialty Pharmacies for use by our East Region Providers for TRICARE beneficiaries. Specialty pharmacies are not retail pharmacy providers and much of what they offer is a part of the TRICARE medical benefit, not pharmacy benefit. Several of the listed specialty pharmacies include a “drug list or formulary”, all others listed without a formulary expect the provider to contact directly to determine if a particular drug/item is available to order. Beneficiaries are not allowed to contact one of the specialty pharmacies as it is not retail, but available for physician order only. The process includes a prescription/referral form with a fax number the provider must submit per TRICARE patient, per episode of care. Why is this a value add for providers? The specialty pharmacy selected for the service takes the responsibility to bill the drug item directly to the TRICARE claims processor. This alleviates the ordering provider from having to file the drug portion of the claim with the NDC# and unit/dosage amount per injection. All the provider has to file is the patient visit or admin fee for the same date of service.
Our newest additions for providers to obtain IUDs and several pediatric vaccines come from SkyeMed, one of our premiere specialty pharmacies.
- J7301 – Skyla IUD (as of June 1st)
- J7302 – Mirena IUD (since Nov. 2014)
- 90670 – Prevnar 13 (vaccine) NEW as of July 1st
- 90680 – Rotavirus Vaccine (3 dose) NEW as of July 1st
- 90681 – Rotavirus Vaccine (2 dose) NEW as of July 1st