Pharmacy
The TRICARE Pharmacy Program provides prescription medication to TRICARE beneficiaries. This program is managed by Express Scripts. Encourage your patients to create an account at militaryrx.express-scripts.com to start home delivery, order refills or check order status.
Approval, including medical necessity verification, may be required from Express Scripts for some medications. This may include:
- non-formulary medications,
- brand-name medications with generic equivalents,
- medications with age limitations,
- prescriptions for quantities exceeding normal limits, or
- medications specified by the Department of Defense Pharmacy and Therapeutics (P&T) Committee.
Visit TRICARE’s Prescription Drugs page to learn more about generic and brand-name formulary, non-formulary and non-covered medications or search the TRICARE Formulary tool.
See also Injection/Infusion Medication and Pain Management.
Cost Information
ePrescribe
E-prescribe is a simple and secure way to send prescriptions to your patients' pharmacy of choice. You can use ePrescribe at military pharmacies, TRICARE Pharmacy Home Delivery and participating retail pharmacies.
- Add your patients' preferred pharmacy. If sending to a military pharmacy, search for "DoD <site name> ePhcy"
- To set up TRICARE Pharmacy Home Delivery for your patient, select "Express Scripts Home Delivery" in their pharmacy listing.
You can now e-prescribe controlled substances to some military pharmacies. Visit www.health.mil to see a list of participating pharmacies.
Visit www.health.mil and Express Scripts' ePrescribe page to learn more.
Prescription Monitoring Program
The Prescription Monitoring Program (PMP) is made up of two distinct programs: Beneficiary PMP and Provider PMP. The Beneficiary PMP is a quarterly review of controlled substance pharmacy claims to identify beneficiaries that may need care coordination and/or pharmacy restrictions to promote safe and effective use of these medications. The Provider PMP is a quarterly review of provider opioid prescribing patterns to identify providers that may need educational resources or further practice review.
Beneficiary PMP:
- Quarterly, Express Scripts will provide Health Net Federal Services, LLC (HNFS) with a list of TRICARE West Region beneficiaries identified with a high use of controlled substances (Schedule II-V). Other non-controlled substances may be included if they are known to be combined with Schedule II-V for purposes of substance abuse; however, it is not the intent of the program to restrict care for non-chronic pain-related drugs or services.
- HNFS will prioritize and review this list of beneficiaries, along with their pharmacy claims and medical information to determine if there is a need for a beneficiary support plan. Support plans may include case management, pain management, mental health services, and restrictions to medications. HNFS will notify Express Scripts of any recommended restrictions, including denials of related drug claims.
- Upon a decision to place restrictions, Express Scripts will send a letter to impacted beneficiaries and any providers who prescribed controlled substances to them in the past 180 days. Beneficiaries receiving a letter will be asked to select a single provider for pain management and a primary emergency department. A beneficiary who is placed in the PMP may be held responsible for 100 percent of pharmacy costs for all controlled medications if he or she:
- Fails to make these designations within 14 calendar days from the date of the letter, or
- Seeks services from someone other than the designated provider or hospital for controlled medications
Use our PMP web tool to easily determine if your TRICARE patients have any prescription restrictions.
Provider PMP:
- Quarterly, DHA will provide HNFS with a list of West Region providers who have prescribed controlled substances.
- HNFS medical directors will review prescribing practices based upon industry best practices and clinical practice guidelines.
- Providers who fall outside of what are considered normal prescribing patterns may be contacted by HNFS with the following:
- education to include TRICARE covered benefits that may complement treatment, such as substance use disorder and mental health treatment, alternative pain-related treatments; and
- training for programs such as national and state Prescription Drug Monitoring Programs (PDMP) and the Substance Abuse and Mental Health Services Administration (SAMHSA).
The Centers for Disease Control and Prevention (CDC) has written the Guideline for Prescribing Opioids for Chronic Pain to assist providers in determining the appropriate time to introduce and ways to manage opioids for the treatment of pain.
Additional Information
