TRICARE Formulary

You can find out if your medication is covered by looking it up on the Formulary Search Tool.

A limited list of medications are classified as Tier 4 Non-Covered. These drugs are not covered for any beneficiary at any pharmacy. Medical Necessity and Prior Authorization are not available for these medications. These drugs have alternatives available. Check the Formulary Search Tool and speak with your provider about alternative medications.

NOTE: In some cases your medication (injections and vaccines) may be covered as a medical benefit so you can call your TRICARE Regional Contractor.

You can contact Express-Scripts Customer Service @ 1-877-363-1303 for information regarding the appeals process.

You can find out if generic is required by looking it up on the Formulary Search Tool.

Your provider can either call the Express-Scripts prior authorization line @ 1-866-684-4488 to establish medical necessity or he/she can fill out the Brand over Generic Prior Authorization Request Form and fax it to Express-Scripts.

You can contact Express-Scripts Customer Service @ 1-877-363-1303 for information regarding the appeals process.

You can find out if your medication requires prior authorization by looking it up on the Formulary Search Tool.

Your provider can either call the Express-Scripts prior authorization line @ 1-866-684-4488 or he/she can fill out the prior auth form that is linked to that medication on the Formulary Search Tool and fax it to Express-Scripts.

You can contact Express-Scripts Customer Service @ 1-877-363-1303 for information regarding the appeals process.

You can find out if your medication requires medical necessity by looking it up on the Formulary Search Tool.

Your provider can either call the Express-Scripts prior authorization line @ 1-866-684-4488 to establish medical necessity or he/she can fill out the medical necessity form that is linked to that medication on the Formulary Search Tool and fax it to Express-Scripts.

You can contact Express-Scripts Customer Service @ 1-877-363-1303 for information regarding the appeals process.

You can look up your medication on the Formulary Search Tool. These will be listed under the "Notes" section.

Your provider will need to call the Express-Scripts Prior Authorization line @ 1-866-684-4488 to establish medical necessity.

You can contact Express-Scripts Customer Service @ 1-877-363-1303 for information regarding the appeals process.

You can find out if there are quantity limits on your medication is covered by looking it up on the Formulary Search Tool. These will be listed under the "Notes" section.

Your provider can call the Express-Scripts PA line @ 1-866-684-4488 to establish medical necessity for a quantity limit override.

You can contact Express-Scripts Customer Service @ 1-877-363-1303 for information regarding the appeals process.

You can contact Express-Scripts Customer Service @ 1-877-363-1303 for assistance.

The following websites have medication information like indications and side effects: 

• www.drugs.com
• www.rxlist.com
• www.webmd.com