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Pharmacy Program

TRICARE Home Delivery Pharmacy Registration Form

Use this form to register for TRICARE Pharmacy Home Delivery services. Contact your doctor to write a new prescription for up to a three-month supply with authorized refills for up to one year.

  • Complete the form
  • Attach your prescriptions to the order form-clearly write your name, sponsor ID number and date of birth on the back of the prescription.
  • Mail the New Patient Mail Order Form and your prescriptions to:

Express Scripts, Inc.
P.O. Box 52150
Phoenix, AZ 85072-9954

Your doctor can fax this form to Express-Scripts at:

  • 1-877-895-1900
  • 1-602-586-3911 (overseas)

You can also complete your registration over the phone. Call 1-877-363-1296 and have your prescription bottle handy. A patient care advocate will work with your doctor to transfer your maintenance medications to Home Delivery. 

Or, you can activate your account online.

Medical Necessity Forms

Go to this page to find the medical necessity form you or your provider needs to establish medical necessity for non-formulary medications. Search the chart and download the form you need.

Prior Authorization Forms

Some prescriptions require prior authorization. Go to this page to search the chart and download the form you need.

Last Updated 5/1/2014