Certain Maintenance Drugs
Do you take drugs regularly for a chronic condition like high cholesterol or high blood pressure? These are certain maintenance drugsAny drug you take regularly for a chronic condition..
You have to refill certain maintenance drugs through home delivery or at military pharmacies. This doesn’t apply to active duty service members.
Is My Drug Affected?
To check, you can:
Filling Prescriptions for Certain Maintenance Drugs
When you get a prescription for a drug on the Certain Drug List:
- You can fill it up to twice at a network pharmacy
- After that, you need to switch it to home delivery or to a military pharmacy.
- If you continue to fill your prescription at a network pharmacy, you’ll pay the full cost.
|Switch to Home Delivery||Switch to a Military Pharmacy|
Exceptions to the Rule
There are times when you may not be required to switch to home delivery or a military pharmacy.
You Use Generic Drugs
If your brand name drug has a generic substitute, you can use the generic instead. You can fill most generic drug prescriptions at a network pharmacy.
You May Qualify for a Waiver
You can call Express Scripts at 1-877-363-1303 to request a waiver. If you get a waiver, you can go to a network pharmacy without penalty. Waivers are granted on a case-by-case basis for:
- Personal needs
- Special circumstances, such as living in a nursing home
You Have Other Health InsuranceHealth insurance you have in addition to TRICARE, such as Medicare or an employer-sponsored health insurance. TRICARE supplements don’t qualify as "other health insurance."
Typically, you can't use home delivery when you have other health insurance. You may have to use your TRICARE pharmacy benefit if:
- Your other plan doesn't include pharmacy benefits,
- Your other plan doesn't cover the drug you need, or
- You have met the benefit cap of your other plan.
You Live Overseas
This requirement only applies to prescriptions filled in the U.S. and U.S. Territories.
You're on Active Duty
This requirement doesn't apply to active duty service members.
Last Updated 6/18/2020