TRICARE provides a pharmacy benefit to all eligible service members, including beneficiaries entitled to Medicare Part A and B based on their age. Eligible beneficiaries may fill prescription medications at military treatment facility (MTF) pharmacies; through the TRICARE Express Scripts, Inc. (Express Scripts); at TRICARE retail network pharmacies; and at non-network retail pharmacies. Prescriptions filled through the MTF, TRICARE Pharmacy Home Delivery, and retail network pharmacies are checked for accuracy and are checked against your TRICARE prescription history for potential drug interactions. To have a prescription filled; beneficiaries need a written prescription and a valid Uniformed Services identification card.

DFAS will provide IRS Form 1095-C to all U.S. military members, and IRS Form 1095-B to all Retirees, Annuitants, former spouses and all other individuals having TRICARE coverage during all or any portion of tax year 2023. An IRS Form 1095 documents you (and your family members, if applicable) have the minimum essential coverage. These forms will document the information that DFAS will provide to the IRS on yourself and your authorized family members. According to the IRS, these forms are not required to prepare or file income tax returns but will be available via myPay no later than 31 January 2024.

Retired Air National Guard Service members and TRICARE eligible family members are eligible for TRICARE Pharmacy Benefits; however, they do not obtain TRICARE eligibility until age 60.

Beneficiaries who turned 65 before 1 April 2001 may participate in the program without being enrolled in Medicare Part B. Beneficiaries who turn 65 on or after 1 April 2001 must be enrolled in Medicare Part B and must ensure their DEERS profile is updated to participate.

TRICARE's mandatory generic drug policy requires that prescriptions be filled with a generic product if one is available. In the United States, all generic drugs must undergo Food and Drug Administration testing and approval and are considered safe alternative to brand-name drugs.

Beneficiaries pay the pharmacy copayment based on whether the prescription medication is classified as a formulary generic (Tier 1), formulary brand name (Tier 2), or non-formulary (Tier 3) drug. The copayment depends on where the beneficiary chooses to fill their prescription.

All TRICARE-eligible beneficiaries who are registered in Defense Enrollment Eligibility Reporting System (DEERS) are automatically eligible for the retail network pharmacy option. This option allows you to fill your prescriptions at TRICARE retail network pharmacies throughout the country without having to submit a claim. You have access to a network of approximately 60,000 retail pharmacies in the United States and its territories (American Samoa, Guam, the Northern Mariana Islands, Puerto Rico, and the U.S. Virgin Islands ). Registration is not required. To find the nearest TRICARE retail network pharmacy, visit https://militaryrx.express-scripts.com/ or call 1-877-363-1303 (TDD/TTY: 1-877-540-6261). There is a change to automatic refills. Starting January 1, 2023, you will need to approve each refill before the Express Scripts Pharmacy can ship your medication. This will help make sure you only get the refills you need. Learn more about this change to automatic refills.

Active duty Service members do not pay copayments for prescriptions. However, if they receive medications through an overseas pharmacy or an out-of-network pharmacy, they may need to pay out-of-pocket for the total cost of the medication and then file a claim for reimbursement for the full amount.

TRICARE Pharmacy Costs

*For all beneficiaries except active duty service members, select brand-name maintenance medications (taken for long-term conditions) may only be filled twice at retail and then must be filled via home delivery or military pharmacy.

Using Other Health Insurance (OHI): You are not eligible to use TRICARE Pharmacy Home Delivery if you have other health insurance (OHI) with a prescription plan, including a Medicare Part D prescription program, unless you meet one of the following requirements:

• Your OHI does not include pharmacy benefits

• The medication you need is not covered by your OHI

• You have met your OHI's benefit cap (i.e., you have met your benefit's maximum coverage limit)

Once you have met one of these requirements, you may submit your prescription to TRICARE Pharmacy Home Delivery. You will need to send proof from your other plan that it is not covered, or you have met the benefit cap.

Ask your provider to write the prescription for the maximum supply allowed, which is 90 days for most drugs. There are three ways to send new prescriptions to Express Scripts for Home Delivery.

Beneficiaries residing in Germany must use a military pharmacy or host nation pharmacy.

If your OHI provides only medical coverage (not pharmacy coverage), you still may be eligible to use TRICARE Pharmacy Home Delivery as your prescription benefit. For more information, call Express Scripts, Inc. at 1-877-363-1303 (TDD/TTY: 1-877-540-6261).

Having OHI does not prevent you from using TRICARE retail network pharmacies. If you have pharmacy benefits through your OHI, TRICARE becomes the second payer by law.

Note: Supplemental and discount prescription drug programs, such as Senior Friends and American Association of Retired Persons, do not count as OHI pharmacy coverage.

For more information, please visit the TRICARE Pharmacy Program webpage maintained by the

TRICARE Management Activity:
https://tricare.mil/pharmacy.aspx

TRICARE Pharmacy Program Handbook:
https://tricare.mil/-/media/Files/TRICARE/Publications/Handbooks/TRICARE_Pharmacy_Program_Handbook_June_2023_FINAL_063023_508.pdf 

TRICARE DEERS Information:
https://tricare.mil/DEERS