Pharmacy Claims

You will need to file a claim for reimbursement if:

• You get your prescription filled at a non-network pharmacy, or
• 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." with pharmacy benefits

You must file your claim within one year of the date of service.   

Required Info with Your Claim

• Fill out a Patient’s Request for Medical Payment (DD Form 2642).
• You must send the form and the following information with your claim.
• If you have other health insurance, you should send an explanation of benefits (EOB).

CAN'T be Handwritten on the EOB or Pharmacy Receipt	CAN be Handwritten on the EOB or Pharmacy Receipt
Date of fill Quantity Pharmacy name What you (the beneficiary) paid Drug name and strength	Number of day’s supply Prescription number Pharmacy address Doctor’s name or DEA number Pharmacist’s signature (for retail pharmacy claims only) Amount paid by the other health plan or the retail price from the pharmacy

Claims Filing Addresses

In the U.S. or a U.S. Territory, file your claim with the pharmacy contractor:

Express Scripts, Inc.
P.O. Box 52132
Phoenix, AZ 85072-2132

In an overseas area (other than a U.S. Territory), file your claims with the overseas claims processor, at the appropriate address.

Active Duty All Overseas Areas	TRICARE Active Duty Claims P.O. Box 7968 Madison, WI 53707-7968 www.tricare-overseas.com
Eurasia-Africa Non-active duty	TRICARE Overseas Program P.O. Box 8976 Madison, WI 53708-8976 www.tricare-overseas.com
Latin America & Canada Non-active duty	TRICARE Overseas Program P.O. Box 7985 Madison, WI 53707-7985 www.tricare-overseas.com
Pacific Non-active duty	TRICARE Overseas Program P.O. Box 7985 Madison, WI 53707-7985 www.tricare-overseas.com