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.
TRICARE encourages you to focus on your mental health during the holidays and throughout the year. There are steps you can take and resources you can use to manage the holidays. Remember, you’re not alone, and help is close at hand.

Holiday Resilience: How TRICARE Supports Your Me...

News
Nov. 29, 2023

For many people, the holiday season brings expectations of joy. But for some, the holidays may be a time of...
Read More
TRICARE Open Season is here. Now through Dec. 12, most people enrolled in or eligible for TRICARE Prime or TRICARE Select can make enrollment changes for next year. Open season doesn’t apply to everyone who uses TRICARE.

Does TRICARE Open Season Apply to Me?

News
Nov. 20, 2023

TRICARE Open Season is here. Now through Dec. 12, most people enrolled in or eligible for TRICARE Prime or...
Read More
U.S. Air Force Senior Airman Connor Colassaco, 52nd Medical Group pharmacy vault custodian, reaches for medication at Spangdahlem Air Base, Germany, Dec. 14, 2022. Members of the pharmacy count and label all controlled medication to ensure it is properly inventoried. (U.S. Air Force photo by Senior Airman Jessica Sanchez-Chen)

Getting TRICARE Prescriptions Overseas

News
Nov. 16, 2023

No matter where you live or travel, it’s important to have the prescription drugs you need. To help make this...
Read More
TRICARE Open Season 2023, November 13-December 12, 2023

TRICARE Open Season Is Here: Explore Your Health...

News
Nov. 13, 2023

TRICARE Open Season begins Nov. 13. For many TRICARE beneficiaries, this is your chance to enroll in a health...
Read More
Pharmacist in military pharmacy

Find Out What Your TRICARE Pharmacy Costs Will B...

News
Nov. 09, 2023

Do you get prescription drugs through the TRICARE Pharmacy Program? Copayments for most beneficiaries are...
Read More
Join us for a TRICARE Facebook Live on open season on Nov. 16 at 2 p.m. ET. For more information, visit www.facebook.com/tricare

Learn About TRICARE Open Season During Nov. 16 F...

News
Nov. 08, 2023

Do you need help understanding your health plan options during TRICARE Open Season? Join us for a TRICARE...
Read More
Airman hugging kids.

Know Your 2024 TRICARE Health Plan Costs

News
Nov. 07, 2023

With a new year fast approaching, you may see changes to your TRICARE health plan costs starting on Jan. 1,...
Read More
Service member gets flu shot from other service member.

Protect Your Family With Flu, COVID-19, and RSV ...

News
Nov. 02, 2023

Are you preparing to spend time with friends and family this holiday season? Now is a good time to make sure...
Read More

Nov. 29, 2023

Holiday Resilience: How TRICARE Supports Your Mental Health

For many people, the holiday season brings expectations of joy. But for some, the holidays may be a time of stress, sadness, or isolation. Life events like the deployment of a spouse, the loss of a loved one, and complex family dynamics can affect how we feel during the holiday season.

Nov. 20, 2023

Does TRICARE Open Season Apply to Me?

TRICARE Open Season is here. Now through Dec. 12, most people enrolled in or eligible for TRICARE Prime or TRICARE Select can make enrollment changes for next year. Open season doesn’t apply to everyone who uses TRICARE.

Nov. 16, 2023

Getting TRICARE Prescriptions Overseas

No matter where you live or travel, it’s important to have the prescription drugs you need. To help make this possible, your TRICARE pharmacy benefit is available worldwide. But overseas, your pharmacy options may vary.

Nov. 13, 2023

TRICARE Open Season Is Here: Explore Your Health Plan Options

TRICARE Open Season begins Nov. 13. For many TRICARE beneficiaries, this is your chance to enroll in a health plan or change health plans for coverage that starts Jan. 1, 2024. You can make these changes through Tuesday, Dec. 12.

Nov. 9, 2023

Find Out What Your TRICARE Pharmacy Costs Will Be In 2024

Do you get prescription drugs through the TRICARE Pharmacy Program? Copayments for most beneficiaries are changing. The new costs will start Jan. 1, 2024.

Nov. 8, 2023

Learn About TRICARE Open Season During Nov. 16 Facebook Event

Do you need help understanding your health plan options during TRICARE Open Season? Join us for a TRICARE Facebook Live event on Nov. 16 at 2 p.m. ET.

Nov. 7, 2023

Know Your 2024 TRICARE Health Plan Costs

With a new year fast approaching, you may see changes to your TRICARE health plan costs starting on Jan. 1, 2024. These costs may include enrollment fees, premiums, cost-shares, and copayments.

Nov. 2, 2023

Protect Your Family With Flu, COVID-19, and RSV Vaccines

Are you preparing to spend time with friends and family this holiday season? Now is a good time to make sure you and your loved ones are up to date with COVID-19, flu, and RSV vaccines. TRICARE covers these vaccines based on Centers for Disease Control and Prevention (CDC) recommendations.

Oct. 24, 2023

Patient Advocates and Beneficiary Counseling and Assistance Coordinators Help You Understand Your Health Care Benefit

You probably received medical care in a military hospital or clinic before. But did you know these facilities come with a support staff of people who can help you navigate the health care process? These include patient advocates and Beneficiary Counseling and Assistance Coordinators (BCACs). You can find them at most military hospitals and clinics around the world.

Oct. 12, 2023

Choosing Between TRICARE Prime and TRICARE Select

Want to learn more about choosing between TRICARE Prime and TRICARE Select during TRICARE Open Season? Then join us for “Choosing Between Prime and TRICARE Select” webinar on Oct. 26 at 1 p.m. ET to learn more about this year’s open season.