Non-Formulary Drugs

Do you have a prescription for a drug that is non-formularyAny drug in a therapeutic class determined to not be as clinically-effective or as cost-effective as other drugs in the same class.? You can find a list of alternative drugs by searching the TRICARE Formulary. You'll also find a link to the medical necessity criteria and forms.

Search the TRICARE Formulary Button

  • You can get non-formulary drugs filled for a higher cost through home delivery and at most retail network pharmacies.
  • Some non-formulary drugs are only covered through home delivery.
  • You can get the non-formulary drugs at the formulary cost share (or at no cost for active duty) if your provider can establish medical necessity. >>View Prescription Costs

Get Medical Necessity

  1. Search the chart with medical necessity criteria and forms. We list the drugs by therapeutic class, brand name, and generic name.
  2. Download and print the form for your prescription drug.
  3. Give the form to your provider to complete.
  4. Send the form to Express Scripts.
    • Follow the instructions on the completed form.
    • You don’t need to submit multiple forms. 
    • Your medical necessity approval will apply at network pharmacies and home delivery.

Can't Find a Form?

Non-Formulary Prescriptions at Military Pharmacies

You can fill your prescription for a non-formulary drug at a military pharmacy ONLY IF:

  • Written by a provider at that military hospital or clinic, and
  • Medical necessity is established. 

Military pharmacies aren’t required to fill a prescription for a non-formulary drug written by a civilian provider, but MAY do so IF:

  • You were referred to the civilian provider, and
  • Medical necessity is established.

Last Updated 11/17/2014

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Express Scripts, Inc.

Stateside: 1-877-363-1303
Overseas: 1-866-275-4732
(where toll-free service is established)

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