Non-Formulary Drugs

Non-formulary drugsClick to closeA drug in a therapeutic class that isn’t as clinically or cost-effective as other drugs in the same class. You pay a higher cost share for these drugs. are covered with a higher cost shareClick to closeA percentage of the total cost of a covered health care service that you pay. than drugs in the generic formulary or brand-name formulary categories >>View Pharmacy Costs

  • Some non-formulary drugs are only covered through home delivery.
  • If your provider can establish medical necessity, you can get the non-formulary drugs at the formulary cost share (or at no cost for active duty).  

How to Get Medical Necessity for Non-Formulary Drugs

  • Search for your drug on the TRICARE Formulary Search Tool
  • Download and print the form for your drug.
  • Give the form to your provider to complete and send back to Express Scripts.
    • Instructions are on the form
    • You don’t need to send 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 2/22/2019