Non-Formulary Drugs

Non-formulary drugsAny drug in a therapeutic class determined to not be as clinically-effective or as cost-effective as other drugs in the same class. can be filled through home delivery or at most retail network pharmacies, but at a higher cost. If your provider can establish medical necessity for the non-formulary drug, you can get it filled for the lower "formulary" cost share (or at no cost for active duty). >>View Costs

To 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 to both the retail network pharmacy and home delivery.

When you search the TRICARE Formulary and your drug is identified as "non-formulary," you'll be given a list of alternative formulary drugs and a link to the medical necessity criteria and forms.

Search the TRICARE Formulary Button

If you can’t find a form, send a message to DOD.customer.relations@express-scripts.com and Express Scripts will contact you.

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 1/14/2014

contact Your Contacts
Express Scripts, Inc.

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

www.express-scripts.com/tricare
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