Tier 3 Non-formulary Prescription Information
Tier 3 non-formulary medication will not be available at Military Treatment Facility (MTF) pharmacies unless certain conditions are met.
1) You need to be enrolled to receive care at the MTF
2) The medication must be prescribed by an MTF provider; and
3) All medical necessity and/or prior authorization requirements have been met and approved. If you are enrolled to an MTF provider and were referred to a civilian provider for care, prescriptions from that civilian provider will be honored as well if they meet all medical necessity and/or prior authorization requirements.
This is not a new Defense Health Agency policy, but a restatement of a long-standing Health Affairs policy (HA Policy 04-032). Also, this should not be interpreted to mean you can no longer get any prescriptions written by a civilian provider at the MTF pharmacy.
We will gladly still fill any Tier 1 and Tier 2 formulary medications. If you have questions about the Tier level or medical necessity/prior authorization requirements of a particular medication, we encourage you to check the TRICARE Formulary Search Tool.
TRICARE Formulary Search Tool
Use the TRICARE Formulary Search Tool to look-up your drug. A search can tell you:
- Formulary status (generic drug, brand-name drug, non-formulary drug, non-covered drug)
- Where the prescription can be filled
- Copayments and limitations, such as prior authorization
- Coverage review requirements and forms
- Alternative medications, including costs
To start your search, you’ll need to put in the brand name or generic name of the drug and then select the strength prescribed, as well as your gender and age.
What You Should Do
If you are currently receiving a Tier 3, non-formulary medication at the MTF, discuss this information with your healthcare provider or pharmacist to see which one of the following options is best for you:
- Continue filling your current non-formulary prescription through the TRICARE Home Delivery program. Options for getting your prescription(s) transferred include:
- Call 877-363-1296 to speak with an Express Scripts patient advocate to get your prescription transferred.
- Have your provider mail, fax, or electronically prescribe a new prescription directly to Express Scripts.
- Have your provider change your prescription to an alternative formulary medication available at your MTF.
Co-Pays for Non-Formulary Prescriptions Outside of MTFs
Non-formulary prescriptions filled through TRICARE Home Delivery will require a $53 co-pay per 90 day supply of medication through 31 December 2019. This equates to less than $18 per month for your non-formulary medications which is well below commercial insurance prices.
If you have any questions regarding this policy, please contact the Lyster Army Health Clinic Pharmacy at (334) 255-7830.