TRICARE pharmacy rules
Copays, prior auth and appeals.
Home delivery is cheaper, and for some drugs it’s required. Details below.
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1. Where to fill, and what it costs
Express Scripts runs the TRICARE pharmacy benefit. These are retiree and family copays. The Defense Health Agency says they stay in effect through December 31, 2027.
| Drug | Home delivery, 90 days | Retail network, 30 days |
|---|---|---|
| Generic | $14 | $16 |
| Brand-name | $44 | $48 |
| Non-formulary | $85 | $85 |
- Military pharmacy: $0, up to 90 days.
- Non-network pharmacy: pay in full, then file DD Form 2642 with Express Scripts. You get back less than at a network pharmacy.
- Active duty pays $0. Survivors of service members who died on active duty, and medically retired members, have lower copays.
A brand-name drug at home delivery costs $44 for 90 days; at retail, three 30-day fills cost $144.
2. The home delivery rule
Everyone except active duty, TRICARE For Life included, must refill certain brand-name maintenance drugs through home delivery or a military pharmacy. You get a letter after the first retail fill and another after the second. On the third, you pay 100%. The rule doesn’t apply if you live overseas, or if other health insurance with drug coverage, such as FEHB, pays first. The drug list is at tricare.mil/maintenance.
To switch, call Express Scripts at 877-363-1303 or have your doctor send the prescription to home delivery.
3. Prior authorization
Some drugs need Express Scripts to approve them first: drugs with age or sex limits, brand-name drugs that have a generic, and amounts above the normal limit.
- Your prescriber sends it electronically, by phone, or by fax using the number on the drug’s form. The forms are in Express Scripts’ formulary search tool.
- Expect about 10 days for a decision after Express Scripts gets the request.
- Check the end date. Approvals don’t all last the same time. It’s in the letter and in your Express Scripts account.
4. Quantity limits and step therapy
- Quantity limits: TRICARE pays only up to a set amount per fill. More needs your doctor to show it’s medically necessary.
- Step therapy: new users must try a preferred drug first. If you filled the drug in the 180 days before the rule started, you’re generally exempt.
- Non-formulary drugs: if Express Scripts agrees you need one, you pay the formulary copay instead.
- Brand when a generic exists: without approval, you pay the full price.
5. How to appeal
- Write to Express Scripts within 90 days of the decision. Sign it, say why you disagree, and include a copy of the denial.
- Mail it to Express Scripts, Inc., P.O. Box 60903, Phoenix, AZ 85082-0903.
- Missing papers? File on time anyway and say more is coming.
- Denied again? The denial letter explains the next level and its deadline.
Ask your doctor for a letter explaining why you need the drug. That’s usually what wins an appeal.
6. GLP-1 drugs and TRICARE For Life
TRICARE For Life stopped covering GLP-1 drugs such as Wegovy and Zepbound for weight loss on August 31, 2025. They’re still covered for diabetes when prior authorization criteria are met. Your options are in the Medicare GLP-1 bridge and TRICARE For Life.
Have FEHB too? See TRICARE For Life and FEHB and suspending FEHB for TRICARE. Rated by the VA? Warrior Disability’s calculator adds VA pay to your retired pay. Working for the government now? Federal Warrior’s FERS pension estimator projects a second pension. Weighing FEHB? Warrior Insure’s FEHB premium estimator shows 2027 premiums.
7. Frequently asked questions
Who runs the TRICARE pharmacy benefit?
Express Scripts, under contract with the Defense Health Agency. It runs home delivery, the retail network and prior authorizations. Call 877-363-1303.
What are TRICARE pharmacy copays for retirees?
For 2026 and 2027: home delivery, 90 days, $14 generic, $44 brand-name and $85 non-formulary. Retail network, 30 days, $16 generic, $48 brand-name and $85 non-formulary. Military pharmacies are $0. Active duty pays nothing.
Do TRICARE For Life users have to use home delivery?
For certain brand-name maintenance drugs, yes. Everyone except active duty must refill them through home delivery or a military pharmacy. After two retail fills with warning letters, you pay the full cost on the third. It doesn’t apply overseas or when other insurance with drug coverage, such as FEHB, pays first. The list is at tricare.mil/maintenance.
How long does TRICARE prior authorization take?
Express Scripts usually decides about 10 days after it gets the request from your prescriber. Your prescriber can send it electronically, by fax or by phone. The approval letter shows how long it lasts.
How do I appeal a TRICARE pharmacy denial?
Send Express Scripts a signed, written request for reconsideration within 90 days of the decision. Say why you disagree and include a copy of the denial. Mail it to Express Scripts, Inc., P.O. Box 60903, Phoenix, AZ 85082-0903. If it’s denied again, the letter tells you the next step.
Does TRICARE For Life cover Wegovy or Zepbound for weight loss?
No. TRICARE For Life stopped covering GLP-1 drugs for weight loss on August 31, 2025. They are still covered for diabetes when prior authorization criteria are met.
Copays for retirees and families, 2026 to 2027. Check your own drug with Express Scripts. Not medical advice.