Pharmacy Program

TRICARE Home Delivery Pharmacy Registration Form

Use this form to register for TRICARE Pharmacy Home Delivery services. Contact your doctor to write a new prescription for up to a three-month supply with authorized refills for up to one year.

• Complete the form
• Attach your prescriptions to the order form-clearly write your name, sponsor ID number and date of birth on the back of the prescription.
• Mail the New Patient Mail Order Form and your prescriptions to:

Express Scripts, Inc.
P.O. Box 52150
Phoenix, AZ 85072-2150

Your doctor can fax this form to Express-Scripts at:

• 1-877-895-1900
• 1-602-586-3911 (overseas)

You can also complete your registration over the phone. Call 1-877-363-1303 and have your prescription bottle handy. A patient care advocate will work with your doctor to transfer your maintenance medications to Home Delivery. 

Or, you can activate your account online.

Brand Name over Generic Pre-Authorization Request

Your provider will use this form to request pre-authorization to use a brand name drug instead of a generic alternative.

• Complete the form
• Attach the completed form to the prescription.

Your provider can email, fax or send it in the mail:

Email: TpharmPA@express-scripts.com

Fax: 1-866-684-4477

Mail the form to:

Express Scripts, Inc.
P.O. Box 52150
Phoenix, AZ 85072-2150

Medical Necessity Forms

• 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.

Pre-Authorization Forms

• 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 authorization approval will apply to network pharmacies and home delivery.