Your Guide to TRICARE Pharmacy Program Rules

FALLS CHURCH, Va. –

Do you have a new prescription that you need filled? Or maybe you’ve been taking the same medicine for years. It’s good to know some keywords to find your medicine at a low price.

“Your medical needs and your health plan can affect what you pay at the pharmacy,” said Air Force Lt. Col. Leighcraft A. Shakes, Director of TRICARE Pharmacy Contract Support at the Defense Health Center. “It’s important to understand how TRICARE covers different types of drugs. It will help you make sure you get what you need—at the right price.”

Start with this list of keywords.

Formulary drugs are drugs that TRICARE covers. They are available everywhere. There are two categories:

• Common formulary drugs
• Brand name drugs

Generic drugs covered by a TRICARE pharmacy work the same way as brand-name drugs. They offer the same treatment at a lower price. When available, TRICARE usually fills the prescription with the same generic drugs.

Want to know what drugs TRICARE covers? The TRICARE Formulary Search Tool is a resource you can use to learn more about the formulary. Contains information about:

• Coverage and copayments
• Pharmacy types
• Prescription filling options

Drugs that TRICARE does not cover are called non-covered drugs. If TRICARE does not provide a drug, ask your provider about a similar drug. Otherwise, you will pay all costs. After that, you will need to apply for a refund. You will have to pay the applicable cost components, copayments, deductibles, and other costs.

Non-formulary covered drugs are drugs that may cost more than other drugs in the same prescription drug class. All are available through TRICARE Pharmacy Home Delivery at an additional cost.

They are usually not available in military pharmacies. But you can ask your local military pharmacy if they have them. You can also get most of these drugs at TRICARE network pharmacies.

You can get non-formulary drugs if your provider determines that you have a medical need. Not sure if this applies to you? You can ask your provider for more information.

Want to find the formulary status of your medicine? See the TRICARE Formulary Search Tool.

Special drugs treat severe chronic conditions. They often require special storage and handling. They are not widely available in retail pharmacies. These drugs may have side effects or dosing regimens that your provider should monitor.

Note: Specialty drugs often cost more than generic and brand-name drugs. You can download the TRICARE specialty drug list.

Maintenance drugs treat chronic conditions. These may include drugs that control blood pressure or cholesterol. They are taken regularly over a long period of time.

Are you out of medicine? Finding another supply is easy. But it’s important to know the difference between replenishment and renewal.

A fill again means you can order a new supply of your medicine when you run low. In this case, you don’t have to go through your supplier to get new equipment. Alternatively, you can use the MHS GENESIS Patient Portal to request a refill from your military pharmacy.

Trying to fill a prescription at TRICARE’s online pharmacy? If so, you should contact the pharmacy for details. Some non-prescription drugs are only available through TRICARE Pharmacy Home Delivery or military pharmacies.

Have you used all the supplements for your prescription? You will need to get a new prescription for the same medicine. This means you need to contact your provider to request a renewal. You can do this during a scheduled appointment.

You can also request a renewal through the MHS GENESIS Patient Portal. (Note: In some cases, you may need to see your provider first.)

Knowing pharmacy terms and options can help you maintain your health. It also helps you manage out-of-pocket expenses. For more information, visit the TRICARE Pharmacy Program or see TRICARE Pharmacy General Information Sheet.

Would you like the latest TRICARE news sent to you by email? Visit TRICARE subscriptionsand customize your profile to get details on benefits, news, and more.