FALLS CHURCH, Va. –
Do you have questions about your prescription drug? Maybe you don’t know where you can fill your new prescription, or how much it will cost. TRICARE and its pharmacy contractor,
Express Scripts, provides an online tool where you can search for information on specific drugs to see whether they’re available through the
TRICARE pharmacy benefit. It’s called the
TRICARE Formulary Search Tool.
“The TRICARE Formulary Search Tool is a convenient way to learn about your prescription drugs, so you know your options when managing your medications,” said U.S. Public Health Service Cmdr. Teisha Robertson, a pharmacist with the Defense Health Agency’s Pharmacy Operations Division. “Both you and your doctor can use this pharmacy tool to answer questions about your drug coverage, where you can fill your prescriptions, and any applicable copayments.”
Here are five ways the search tool can keep you informed about your prescriptions.
1. Formulary status (drug category)
The TRICARE pharmacy benefit covers several
types of drugs. If you aren’t sure if TRICARE covers your prescription drug,
you can look it up. The type of drug you get will determine how much you pay, as costs may vary depending on the drug’s category. As outlined in the
TRICARE Pharmacy Program Overview, TRICARE groups prescription drugs into four categories:
Your pharmacy will generally fill your covered prescription with a generic drug. But a provider can prescribe a brand-name drug for you if the provider completes an approval process.
2. Where your prescription can be filled and any applicable copayments
The search tool can show you your
TRICARE pharmacy options for filling your prescription. And it shows you costs based on your beneficiary category and the type of drug you’re prescribed. Your options may include:
The search tool doesn’t show drug information for
non-network pharmacies. If you use a non-network pharmacy, you’ll have to pay full price for your covered prescription drug and
file a claim for reimbursement. Reimbursements are subject to annual deductibles, out-of-network cost-shares, and copayments.
If you live overseas and fill your prescription at a
non-network pharmacy outside the U.S. and U.S. territories (American Samoa, Guam, the Northern Mariana Islands, Puerto Rico, and the U.S. Virgin Islands), you’ll also have to pay the full price of your prescription at the pharmacy and file a claim for reimbursement. You’ll need to
file your claim with the TRICARE Overseas Program claims processor. All deductibles must be met before any reimbursement can be made.
If you’re an active duty service member, you have no copayments for covered drugs when you use military pharmacies, home delivery, or retail network pharmacies. For others, refer to the search tool and
TRICARE Compare Cost Tool to see how much you’ll pay out of pocket. Keep in mind, you may have to meet your annual deductible before copayments or cost-shares apply for certain pharmacy types.
3. Coverage details and limitations
Some drugs require
pre-authorization or
medical necessity forms to be filled out by your doctor before your prescription can be filled. You can find these forms with your prescription drug’s information in the search tool. TRICARE requires pre-authorization for some drugs to make sure they’re safe, effective, medically necessary, and cost-effective. Also, there are times when a doctor may say a non-formulary drug is a medical necessity. If your non-formulary drug meets certain criteria, you can get it at the lower formulary cost.
You can learn more about coverage rules and requirements in the
TRICARE Pharmacy Program Handbook.
4. Drug information
Want to know more about the drug you’re taking? The search tool shows you side effects, quantity limits, or restrictions that may apply to your drug. You can also click on the “About this drug” link for alternate drug names and frequently asked questions.
5. Other drug options
If TRICARE doesn’t cover your prescribed drug, you or your doctor can see if there’s an alternative drug that’s covered. You can also check the search tool to see if there are generic equivalents.
The
TRICARE Formulary Search Tool is easy to use, so get started learning about your prescriptions today. And visit the TRICARE website to learn more about your
pharmacy benefit. If you have questions, you can contact
Express Scripts.