An official website of the United States government
Here's how you know
A .mil website belongs to an official U.S. Department of Defense organization in the United States.
A lock (lock ) or https:// means you’ve safely connected to the .mil website. Share sensitive information only on official, secure websites.

News | Aug. 16, 2022

What to Expect if You Need to File a TRICARE Pharmacy Claim

By TRICARE Communications

When you use the TRICARE Pharmacy Program benefit, you may wonder if you must file claims for reimbursement for prescription drugs. Here’s an overview of when and how to successfully file pharmacy claims.
 
“The TRICARE Pharmacy Program is a comprehensive pharmacy benefit, which offers a number of efficient and cost-effective ways to fill your prescription drugs,” said U.S. Public Health Service Cmdr. Teisha Robertson, a pharmacist with the Defense Health Agency’s Pharmacy Operations Division. “In most cases, you won’t have to file pharmacy claims. However, some pharmacy options will require you to submit a claim, so it’s important to understand the process.”
 
When you don’t need to file a claim
If you’re like most beneficiaries who get your prescription drugs filled at a military pharmacy, through TRICARE Pharmacy Home Delivery, or at a TRICARE retail network pharmacy, you don’t need to file a claim.
 
When you need to file a claim
Under the TRICARE Pharmacy Program, which Express Scripts administers, you’ll need to file a claim for prescription drugs if:
  • You filled your prescription at a TRICARE non-network pharmacy in the U.S. or U.S. territories (American Samoa, Guam, the Northern Mariana Islands, Puerto Rico, and the U.S. Virgin Islands). You’ll pay the full amount of the prescription upfront and file a claim for reimbursement. Remember, reimbursements are subject to deductibles, out-of-network cost-shares, TRICARE formulary status, and applicable copayments.
     
  • You have other health insurance (OHI). OHI may be through your employer or a private plan you’ve purchased. According to the TRICARE Pharmacy Program Handbook, you may need to file a claim if you have OHI that offers pharmacy coverage. 

    ​There are two exceptions, however. You won’t have to pay out of pocket or file a claim if the pharmacy is in network for both your OHI and TRICARE. You must also provide your pharmacist with both your OHI and TRICARE information. The other exception is if the OHI also allows Express Scripts home delivery. In this case, Express Scripts will coordinate with the OHI and TRICARE.

    Reimbursement with OHI requires coordination of benefits to decide how much each company will pay on a claim. Generally, when you have OHI pharmacy benefits, your OHI pays first, and TRICARE pays second.
     
  • There’s the unlikely event of a Defense Enrollment Eligibility Reporting System (DEERS) outage. When an outage occurs, your pharmacist can’t verify your benefits. If this happens, you may need to pay in full for prescriptions filled at a network pharmacy and then file a claim for reimbursement.

In all cases, though, you must file your claim with TRICARE within one year from the date you filled your prescription.
 
How to file a claim if you live in the U.S. or U.S. territories
You have two options: submit a claim online or file a paper claim.
 
Online
It’s easy to submit a claim electronically:
  •  First, log in to your online Express Scripts account
  • Once you’ve logged in, navigate to the “Benefits” menu option and select “Forms”
 
You’ll need to upload and include images of your:
  • Prescriber information, including name, address, and phone number
  • Pharmacy receipt with phone number
  • OHI payment on the claim, if any
 
Keep in mind, you can submit an online claim if you’re coordinating benefits or if the prescription drug:  
By mail
If you prefer to submit your claim through the mail, follow these steps:
  • Complete DD Form 2642
  • Mail DD Form 2642, along with the required paperwork—a copy of your OHI explanation of benefits and your pharmacy receipt—to Express Scripts
 
How to file a claim if you’re overseas
If you fill a prescription overseas, file your claim with your TRICARE Overseas Program claims processor to be reimbursed on covered prescription drugs. You can do this either online through the secure claims portal or by mail. Be sure to submit proof of payment with your overseas pharmacy claims. If you’re in the Philippines, you must get your prescription filled at a TRICARE-certified pharmacy to ensure your claims are reimbursed.
 
Download the TRICARE Pharmacy Program Handbook for everything you need to know about your pharmacy benefit and claims filing. For a quick overview, watch this video on claims filing. You can also reach out to Express Scripts 24/7.
 
Would you like the latest TRICARE news sent to you by email? Visit the TRICARE Subscriptions page today, and create your personalized profile to get benefit updates, news, and more.
Two service members greet each other

Seeking Clinical Mental Health Services? Learn W...

News
Sep. 27, 2022

If left untreated, mental health difficulties could affect your physical health. That’s why TRICARE covers a...
Read More
A woman shows off her smile

Q&A: How Can TRICARE Dental Program’s Wellness P...

News
Sep. 22, 2022

Have you or a family member been diagnosed with a chronic medical condition? If so, you may qualify for extra...
Read More
Signing divorce papers

How Divorce Impacts Your TRICARE Benefits

News
Sep. 20, 2022

The divorce process can create intense emotions. You might feel frustrated or confused during this time...
Read More
A woman standing in the street

Q&A: What You Need to Know for Federal Benefits ...

News
Sep. 12, 2022

The Federal Benefits Open Season starts Nov. 14 and ends Dec. 12, 2022. This open season is for dental and...
Read More
Woman browses her computer while holding a cup

A Checklist to Help You Prepare for 2022 TRICARE...

News
Sep. 12, 2022

TRICARE Open Season starts in the fall. That’s the time when most families can make changes to their TRICARE...
Read More
A graphic promoting the Sept. 29 Webinar

Have TRICARE For Life Questions? Register for Se...

News
Sep. 08, 2022

Will you soon be eligible for Medicare and TRICARE coverage? If yes, be sure to join the TRICARE webinar, “How...
Read More
An adult holds a baby's hand

New Cultural Exemption Affects Midwife Services ...

News
Sep. 01, 2022

Are you living in Germany? Are you planning to have a child? If so, there are some important updates about...
Read More
A doctor looks over her laptop

Make Sure You Understand Recent TRICARE Teleheal...

News
Aug. 30, 2022

At the start of the COVID-19 pandemic, the Defense Health Agency (DHA) made several temporary updates to the...
Read More

Sept. 27, 2022

Seeking Clinical Mental Health Services? Learn What TRICARE Covers

If left untreated, mental health difficulties could affect your physical health. That’s why TRICARE covers a variety of mental health services. These services can help you get care so you can stay balanced, in both mind and body.

Sept. 22, 2022

Q&A: How Can TRICARE Dental Program’s Wellness Program Help You

Have you or a family member been diagnosed with a chronic medical condition? If so, you may qualify for extra benefits. The TRICARE Dental Program has a Wellness Program extending dental benefits for qualified beneficiaries with chronic medical conditions.

Sept. 20, 2022

How Divorce Impacts Your TRICARE Benefits

The divorce process can create intense emotions. You might feel frustrated or confused during this time. Thinking about your TRICARE benefits may be the last thought on your mind. However, it’s something you must consider.

Sept. 12, 2022

Q&A: What You Need to Know for Federal Benefits Open Season

The Federal Benefits Open Season starts Nov. 14 and ends Dec. 12, 2022. This open season is for dental and vision coverage through the Federal Employees Dental and Vision Insurance Program (FEDVIP).

Sept. 12, 2022

A Checklist to Help You Prepare for 2022 TRICARE Open Season

TRICARE Open Season starts in the fall. That’s the time when most families can make changes to their TRICARE health care coverage for next year. Preparing for open season now can help you make the best selection for you and your family later.

Sept. 8, 2022

Have TRICARE For Life Questions? Register for September 29 Webinar

Will you soon be eligible for Medicare and TRICARE coverage? If yes, be sure to join the TRICARE webinar, “How to Get Started With Medicare and TRICARE,” on Sept. 29, from 1 to 2 p.m. ET.

Sept. 1, 2022

New Cultural Exemption Affects Midwife Services for TRICARE Families in Germany

Are you living in Germany? Are you planning to have a child? If so, there are some important updates about midwife services TRICARE covers for families in Germany.

Aug. 30, 2022

Make Sure You Understand Recent TRICARE Telehealth Policy Changes

At the start of the COVID-19 pandemic, the Defense Health Agency (DHA) made several temporary updates to the TRICARE benefit regarding telehealth. These temporary policy updates allowed you to get care safely during the COVID-19 pandemic.

Aug. 25, 2022

TRICARE Helps You Stay On Top of Preventive Health Care

There are many things you can do to stay healthy. Eat nutritious foods. Move your body through exercise or recreation. Stay at a healthy weight. Don’t use tobacco or drugs. Limit alcohol intake. And get plenty of sleep. But an important part of being—and staying—healthy is getting regular preventive health care checkups.

Aug. 23, 2022

Let’s Talk: Youth, Mental Health, and TRICARE

According to the Centers for Disease Control and Prevention, mental health challenges among youth are on the rise nationwide. During childhood, mental wellness is especially important because it contributes to physical health, resiliency, and social skills.

Learn More about COVID-19 and the COVID-19 Vaccine.