News | June 22, 2021

Is Your Prescription Covered? Find Out Using TRICARE Formulary Search Tool

By TRICARE Communications

It’s no secret that taking your medications as prescribed is one of the keys to staying healthy. For you, that could be blood pressure medication. For a family member, it could be medication to treat an allergy. But how do you know if the prescription your doctor wrote for you is something that TRICARE covers? You can find out by looking it up on the TRICARE Formulary Search Tool.
 
“The TRICARE Formulary Search Tool helps you learn about your prescription, where you can fill it, and how much you may have to pay out of pocket,” said U.S. Public Health Service Cmdr. Teisha Robertson, a pharmacist with the Pharmacy Operations Division at the Defense Health Agency. “It’s an easy to use online tool that can help you get the most out of your TRICARE pharmacy benefit.”
 
How does the TRICARE Formulary Search Tool work?
When you’re ready to get started, head over to the search tool and type in the brand or generic name and strength of the drug you need. The “Medicine Name” search bar shows you an example of how you should enter this information. Next, choose the age and gender for whom the prescription is for and click “Search.” This will allow you to see:
  • Coverage results and coverage rules, such as pre-authorization forms or other limitations
  • Information about the drug and where it can be filled
  • Other drug options
  • Your copayment (if applicable)
 
What prescription drugs can I find using the search tool?
You can search for a wide range of prescription drugs. As outlined in the TRICARE Pharmacy Program Handbook, the TRICARE formulary places drugs into four categories:
  • Generic formulary drugs. These are substitutes for brand-name drugs. You can find them in most pharmacies and they cost less than the other options below.
  • Brand-name formulary drugs. These are provided if there isn’t a generic substitute for your prescription or if your doctor completes a clinical assessment that indicates the brand-name drug should be used.
  • Non-formulary drugs. TRICARE also covers these, though availability may be limited. These drugs will usually have higher cost-shares than generic and brand-name drugs, unless your provider can establish medical necessity.
  • Non-covered drugs. TRICARE doesn’t cover these. They may be drugs used to treat a non-covered condition, drugs used for cosmetic purposes, multivitamins, or other products the Food and Drug Administration doesn’t consider to be clinically effective. If you’re prescribed one of these, you’ll have to pay the full price of the drug.
 
“Another way the TRICARE Formulary Search Tool helps is by showing you any quantity limits or restrictions that may apply to your drug and if you need pre-authorization,” Robertson added. “You can also use it to search for alternatives if your prescribed medication has a generic equivalent or isn’t covered.”
 
Where can I get my prescription filled?
Found your covered prescription with the search tool? Now, it’s time to fill it. The TRICARE Pharmacy Program gives you four pharmacy options to fill your prescription:                           
With military pharmacies and home delivery, you can get a 90-day supply of most drugs. Keep in mind, some drugs may only be filled using a certain pharmacy option. Each option is available worldwide, but there may be some limitations overseas.
 
As you search for your prescription, don’t forget to review your costs. As stated in the TRICARE Pharmacy Program Overview, “Active duty service members pay nothing for covered prescriptions from military pharmacies, TRICARE Pharmacy Home Delivery, or TRICARE retail network pharmacies.” If you’re an active duty family member or a retiree, you may have out-of-pocket costs depending on your prescription, TRICARE plan, and where you fill it. The search tool can help you learn more about specific costs for each type of drug.
 
Got more questions? Be sure to contact the pharmacy contractor, Express Scripts, who can answer questions you may have about your prescription drug coverage. Take command of your health, and use the TRICARE Formulary Search Tool to find the medication you need.
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