Prescription Claims

You can file prescription claims online or by mail.

To file a pharmacy claim online, you'll need to register or log in to your Express Scripts account.

To file a claim online, you'll need:

• Your prescriber information
• An image of your pharmacy receipt
• The pharmacy's phone number where you filled your prescription

To file a claim by mail, download and complete the Patient's Request for Medical Payment form (DD Form 2642).

• In the U.S. and U.S. territories: Send your pharmacy claims within one year of the date of service.
• In all other overseas areas: Send your pharmacy claims within three years of the date of service.
• Send the claim form and the following information for each drug.
• If you have other health insurance, include a copy of your explanation of benefits.

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 days’ supply Prescription number Pharmacy address Provider'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 Addresses

In the U.S. or a U.S. territory, send your claim to the pharmacy contractor:

Express Scripts
P.O. Box 52132
Phoenix, AZ 85072

In all other overseas areas, send your claim to the claims address for where you filled the prescription.

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