MAY 17, 2023 – You’re at a medical appointment and you’re getting a new prescription. Before your provider sends an electronic prescription or gives you a paper prescription, it may be helpful for you and your provider to look up the drug with the TRICARE Formulary Search Tool.
“The TRICARE Formulary Search Tool makes it easy to learn about your prescription,” said Melanie Richardson, a pharmacist in the Pharmacy Operations Division at the Defense Health Agency. “You can see if your prescription is covered, where you can fill it, and if your provider needs to request pre-authorization. The tool updates in real time, so information is almost always current.”
While you can use the tool any time you’d like, using it with your provider can be helpful if your provider wants to prescribe a drug you’ve never taken before. Here are some tips on how to use the search tool before you get a new prescription.
How To Use the TRICARE Formulary Search Tool
The TRICARE pharmacy contractor, Express Scripts, hosts the TRICARE Formulary Search Tool. You don’t need to log in to your Express Scripts account to use the tool, so you can use it on a computer or smartphone. Just go to www.express-scripts.com/tform to start a search.
For general information about a drug:
- Type the drug name and strength in the medication search box.
- Beneath the search box, choose your sex and age from the dropdown menus.
- Click “Search” to see information about the drug.
To filter results by drug strength, form, route, or type:
- Click the “Advanced medication search” link.
- Type the drug name and choose your sex and age from the dropdown menus.
- Click “Next” to see a list of results.
- Use the dropdown menus at the top to filter the results.
- Click “Select” next to the drug you’d like to learn more about.
Information You Can Find
Once you’ve looked up your drug, you can find detailed information, including:
- General information about the drug, including what it’s used for, possible side effects, FAQs, and an image of the drug
- The formulary status of the drug
- Coverage details and limitations
- Whether you can fill your prescription at military pharmacies, through home delivery, or at retail network pharmacies
Remember, copayments apply if you aren’t an active duty service member, as outlined in the TRICARE Pharmacy Program Overview Fact Sheet. Copayments also vary based on where you get your prescription filled and if the drug is generic, brand name, or non-formulary.
Pre-Authorization (or Prior Authorization) and Medical Necessity
Depending on the drug you search for, you may see a link that says, “Coverage rules apply.” This often means your provider needs to request pre-authorization or submit proof of medical necessity to Express Scripts. This is often the case for brand-name drugs that have generic equivalents and non-formulary drugs. It can also apply if the drug has age limits. Click “Coverage rules apply” for more information and provider forms.
Other Drug Options
There may be times when you’ll want to see if there are drugs similar to the one you need but with lower out-of-pocket costs or different coverage rules. After you look up a drug, click “Other drug options” beneath the drug’s name to check for similar drugs. And if the drug is available as both a generic drug and a brand-name drug, you can toggle between “generic” and “brand-name” tabs to compare costs and coverage for each.
Using the TRICARE Formulary Search Tool helps you make the best decisions about filling your prescriptions. Check out TRICARE Pharmacy Program to learn more about your pharmacy benefit.
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Defense Health Agency