Using Other Insurance

Do 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? Your other health insurance is the first payer and TRICARE pays second. You can avoid higher costs by getting your prescriptions filled at a TRICARE network pharmacy that is also in your other plan's network.

TRICARE Pharmacy Home Delivery

You can’t use Home Delivery when you have other health insurance, unless:

  • Your health insurance doesn’t include pharmacy benefits,
  • The drug you need isn’t covered by your other plan, or
  • You’ve met the other plan’s benefit cap

If you’ve met any of these requirements, you can get your prescription filled through Home Delivery. You'll need to send proof from your other plan that it isn't covered or you've met the benefit cap.

TRICARE Network Pharmacies

Do you have other health insurance? That doesn’t prevent you from using a TRICARE retail network pharmacy. Your other plan pays first and TRICARE pays second.

Online Coordination of Benefits

When you get your prescriptions at a network pharmacy, tell your pharmacist you also have TRICARE. Your pharmacist will submit your prescription online to both plans at the same time.

When you process your pharmacy claims online, you:

  • Pay minimal out-of-pocket expenses
  • Never pay more than the TRICARE copaymentA fixed dollar amount you may pay for a covered health care service or drug.
  • Don't need to submit paper claims

TRICARE becomes the first payer when:

  • The drug isn't covered by your other plan, but is covered by TRICARE
  • You’ve met the other plan’s benefit cap

If you're using a mail­ order program through your other plan, online coordination of benefits isn't possible.

You must file a prescription claim to get reimbursement for the eligible portion of your out-of-pocket expenses.

Filing Claims with OHI

You must file a prescription claim to get reimbursement for the eligible portion of your out-of-pocket expenses.

Avoid processing delays or problems with your claims by telling Express Scripts you have other health insurance.

Complete a TRICARE Other Health Insurance Form and mail it to:

Express Scripts
P.O. Box 60903
Phoenix, AZ 85082-0903

Once you've met the other plan’s benefit cap, or if your drug isn't covered by your OHI, you can file a claim with TRICARE for reimbursement. To file a claim:

  1. Fill out the TRICARE Claim Form-Patient's Request for Medical Payment (DD 2642)
  2. Mail the form, your OHI explanation of benefits and receipts, to:

Express Scripts, Inc.
P.O. Box 52132
Phoenix, AZ 85082

Ending Other Health Insurance Coverage

Are you no longer covered by other health insurance with pharmacy benefits? You must update your status with the TRICARE pharmacy contractor. >>Contact Express Scripts

Last Updated 5/1/2023