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.
Dentist works on patient's teeth

TRICARE Dental Program Premiums Decrease Effecti...

News
Oct. 30, 2024

If you’re enrolled in the TRICARE Dental Program, your TDP monthly premiums will decrease for coverage...
Read More
TRICARE Open Season Webinar graphic

Get Ready for TRICARE Open Season and 2025 Regio...

News
Oct. 29, 2024

Are you ready for TRICARE Open Season and the upcoming changes to TRICARE in 2025? Mark your calendar for a...
Read More
Woman looking at laptop screen

Q&A: What To Know as TRICARE Open Season Begins ...

News
Oct. 24, 2024

TRICARE Open Season begins Monday, Nov. 11—that’s just a few weeks away. If you’re a TRICARE beneficiary, this...
Read More
Man works on a laptop

TRICARE Claim Form Updated To Assist in Processi...

News
Oct. 23, 2024

If you’ve submitted a claim for reimbursement, then you may be familiar with the TRICARE claim form, Patient’s...
Read More
TRICARE Enrollment Freeze Oct. 25-27, 2024

TRICARE Enrollment Freeze and Scheduled milConne...

News
Oct. 21, 2024

It’s almost time for TRICARE Open Season, which begins Nov. 11. That means you should check your information...
Read More
Man receives a vaccine.

Protect Yourself and Your Loved Ones: Get Your F...

News
Oct. 17, 2024

The fall and winter months bring an increased risk of respiratory illnesses, including flu, COVID-19, and...
Read More
Three women smiling at the camera

Unlock Your Health by Scheduling a TRICARE Well-...

News
Oct. 16, 2024

With TRICARE, you have access to a wide range of preventive care specific to your needs. For women, this...
Read More
Woman sits at table looking at laptop with smartphone next to her.

Live in the West Region? Update Your TRICARE Pay...

News
Oct. 10, 2024

Do you currently live in the West Region? Or, do you live in one of the six states (Arkansas, Illinois,...
Read More

Oct. 30, 2024

TRICARE Dental Program Premiums Decrease Effective Nov. 1

If you’re enrolled in the TRICARE Dental Program, your TDP monthly premiums will decrease for coverage effective Nov. 1. These new rates will remain in effect until Feb. 28, 2025.

Oct. 29, 2024

Get Ready for TRICARE Open Season and 2025 Region Changes at Nov. 14 Webinar

Are you ready for TRICARE Open Season and the upcoming changes to TRICARE in 2025? Mark your calendar for a TRICARE webinar, “Get Ready for TRICARE Open Season and 2025 Region Changes,” on Thursday, Nov. 14, 2–3 p.m. ET on Microsoft Teams Live.

Oct. 24, 2024

Q&A: What To Know as TRICARE Open Season Begins Nov. 11

TRICARE Open Season begins Monday, Nov. 11—that’s just a few weeks away. If you’re a TRICARE beneficiary, this is the time when you can enroll in a health plan or change health plans for coverage that starts Jan. 1, 2025. You can make these changes through Tuesday, Dec. 10.

Oct. 23, 2024

TRICARE Claim Form Updated To Assist in Processing Overseas Claims

If you’ve submitted a claim for reimbursement, then you may be familiar with the TRICARE claim form, Patient’s Request for Medical Payment (DD Form 2642). In September 2024, this form was updated to include fields that’ll make it easier when filing claims for care received overseas.

Oct. 21, 2024

TRICARE Enrollment Freeze and Scheduled milConnect and Beneficiary Web Enrollment Outage Beginning Oct. 25: What To Know

It’s almost time for TRICARE Open Season, which begins Nov. 11. That means you should check your information in the Defense Enrollment Eligibility Reporting System as soon as possible. There will be a global TRICARE enrollment freeze from Oct. 25-27, and limitations to the Beneficiary Web Enrollment self-service portal between Oct. 28 and Dec. 31.

Oct. 17, 2024

Protect Yourself and Your Loved Ones: Get Your Flu Shot With TRICARE

The fall and winter months bring an increased risk of respiratory illnesses, including flu, COVID-19, and respiratory syncytial virus. Getting your flu shot is an easy way to help ward off illness. The vaccine lowers your chance of getting sick, going to the hospital, or even dying from the flu.

Oct. 16, 2024

Unlock Your Health by Scheduling a TRICARE Well-Woman Exam

With TRICARE, you have access to a wide range of preventive care specific to your needs. For women, this includes comprehensive services like an annual well-woman exam.

Oct. 10, 2024

Live in the West Region? Update Your TRICARE Payment Information With TriWest

Do you currently live in the West Region? Or, do you live in one of the six states (Arkansas, Illinois, Louisiana, Oklahoma, Texas, Wisconsin) moving to the West Region in 2025? If you pay for your TRICARE coverage via credit card or bank electronic funds transfer, you can now securely give your recurring payment information to the incoming West Region contractor, TriWest Healthcare Alliance.

Oct. 8, 2024

Learn How Referrals and Specialty Care Will Work as New TRICARE Contracts Start in 2025

Health care delivery under new TRICARE contracts starts on Jan. 1, 2025. These new contracts will improve quality and access for beneficiaries in the United States by enhancing referral management and access to specialty care. Learn more about what to expect starting Jan. 1.

Oct. 7, 2024

DOD Announces Health Care Supplement Program Pilot for DOD Civilian Employees in Japan

The Department of Defense (DOD) today announced a one-year pilot program to provide no-cost supplemental health support services to DOD civilian employees serving in Japan after a yearlong effort to identify and address concerns regarding access to medical care.