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Benefit Summary

A summary of the DoD TRICARE Retail Pharmacy (TRRx) Program is shown below.

To print a full-length copy of the Department of Defense TRICARE Retail Pharmacy Benefit Guide, click here (PDF file).

Advantages of TRRx

The Department of Defense (DoD) TRICARE Retail Pharmacy (TRRx) Program offers several advantages:


  • The TRRx Program allows you to fill your prescriptions at network pharmacies across the country, not just in your region. You can use a network of approximately 55,000 retail pharmacies in the U.S., Guam, Puerto Rico and the U.S. Virgin Islands, or you can choose TRICARE's Mail Order Pharmacy (TMOP) service.


  • Through the DoD TRRx Program, Express Scripts handles all of your retail pharmacy services centrally — no need to call multiple sites or mail information to multiple locations.


  • TRICARE processes all your prescriptions through one database, the Pharmacy Data Transaction Service (PDTS), which helps ensure your safety by checking for drug interactions and warnings for prescriptions you fill through mail order, the retail network or at an MTF.

Eligibility

You must make sure your personal information (status, address, phone number, e-mail) is current in the Defense Enrollment Eligibility Reporting System (DEERS) to ensure eligibility for the retail pharmacy benefit. You can check your DEERS eligibility status by contacting the nearest uniformed services ID card facility. You can also visit the TRICARE website and click on "DEERS Website" to update your address, phone number and e-mail address online. If you have eligibility problems, go to an ID card facility or call the DEERS Support Office at 1.800.538.9552, or for the hearing impaired, call (TTY/TDD) 1.866.363.2883.

Attention Guard/Reservists with Line of Duty Retail Pharmacy Claims
Express Scripts began processing retail pharmacy claims for guard/reservists with approved Line of Duty (LOD) medical conditions as of November 15, 2004. If you have an LOD claim, please complete the DD Form 2642 (PDF file) (CHAMPUS Claim - Patient's Request for Medical Payment) and send it along with a paid receipt (or the invoice from the civilian retail pharmacy) to:

Express Scripts
Attn: TRICARE Claims
P.O. Box 66518
St. Louis, MO 63166-6518

  • The initial mailing of the DD Form 2642 and retail pharmacy receipts to Express Scripts records the transaction into the claims system.

  • Once Express Scripts receives this information, the guard/reservist will be instructed to contact the Military Medical Support Office (MMSO) in Great Lakes, IL. This ensures that a current LOD/Notice of Eligibility letter is on file, in addition to providing MMSO with a copy of Express Scripts' Explanation of Benefits (EOB).
The claim form and procedures for filing a claim are also available from the Guard/Reserve member's unit medical representative.

Copayment/Cost Share Information

The cost of your medication, established by TRICARE, varies according to the type of drug (brand name or generic) the formulary status of the drug and where you get the prescription filled. The following chart outlines the amount you pay for prescription drugs.


TRICARE Pharmacy Copayments*
Where You Fill a
Prescription		 Formulary Nonformulary Drugs
(Tier 3)
Generic Drugs
(Tier 1)		 Brand-Name Drugs
(Tier 2)
Military Treatment Facility (MTF) $0 $0 Not Available
TRICARE Mail Order Pharmacy (TMOP)
(up to a 90-day supply)		 $3 $9 $22
DoD TRRx Network
(up to a 30-day supply)		 $3 $9 $22
Non-network Retail Pharmacy
(up to a 30-day supply)

Note: Beneficiaries must pay
the entire cost of a prescription
at a non-network retail pharmacy
and then submit a claim
(DD Form 2642) (PDF file) for reimbursement.		 TRICARE Beneficiaries Not Enrolled in Prime
$9 (or $22 for nonformulary) or 20% of total cost,
whichever is greater, after deductible is satisfied:
  • E1-E4: $50/person; $100/family
  • All others: $150/person; $300/family
TRICARE Prime Beneficiaries
50% cost-share after point-of-service (POS) deductible has been met.
  • POS deductibles: $300/person; $600/family

*Visit www.tricareformularysearch.org for a comprehensive listing of drugs and copayments for the TRRx benefit.

There are no copayments (the amount you pay out of pocket) for active duty service members using an MTF pharmacy, the TMOP Program or a DoD TRRx network pharmacy. Active duty service members cannot obtain nonformulary drugs from the TMOP or from a TRRx pharmacy until medical necessity has been determined. All other beneficiaries may obtain any nonformulary drug without medical necessity, but you must pay the higher copayment of $22. If medical necessity is established you will be charged the formulary copayment ($9).

Where to Get Your Prescription Filled

TRICARE offers several convenient ways for you to get your prescriptions filled.

Military Treatment Facility (MTF) Pharmacies
An MTF pharmacy provides those medications listed on its local formulary (drug listing). MTF pharmacies accept prescriptions written by both civilian and military providers.

For a complete list of available drugs, contact your nearest MTF in person or by phone.

If an MTF pharmacy is not convenient for you or the medication you need is not available from the local MTF, fill your prescription by using a network retail pharmacy or the TMOP.

TRICARE Mail Order Pharmacy (TMOP)
With TMOP, you can receive up to a 90-day supply* for most medications you take regularly (for instance, drugs for high blood pressure, asthma or oral contraceptives).

When you use the TMOP service you get:
  • Savings: You can save up to 66% over retail costs, because your copayment for a 90-day supply is the same as for a 30-day supply at a retail pharmacy.
  • Convenience and safety: Your medication is mailed to your home in a weather-resistant pouch for your privacy and protection and there is no charge for postage.
To use the TMOP service, just follow these steps:
  1. Ask your doctor for a new prescription (for up to a 90-day supply*, plus refills for up to one year, if appropriate).
  2. Print and complete a TMOP Mail Order Registration Form (PDF file).
  3. Submit your order by mailing your prescription and completed mail order registration to the address shown on the form. Your prescriptions will be mailed to you within 14 days.

For more details on TMOP, please visit the TMOP website or call 1.866.DOD.TMOP (1.866.363.8667).

*The DoD Pharmacy and Therapeutics Committee may set quantity limits on some medications. For more information, go to www.tricare.osd.mil/pharmacy/quant_limits.cfm.

DoD TRICARE Retail Pharmacy (TRRx) Network
Another option for filling your prescription is to use a DoD TRRx network retail pharmacy. Simply give the network pharmacist your written prescription and your uniformed services identification (ID) card. You will pay a copayment of $3 for formulary generic, $9 for formulary brand-name and $22 for nonformulary drugs for up to a 30-day supply.

To find a DoD TRRx network retail pharmacy near you:

  • Use the Pharmacy Locator. The Pharmacy Locator is updated on the first day of each month. If a pharmacy joined after the first day of the month, it might not appear on the locator until the following month.


  • Call 1.866.DOD.TRRX (1.866.363.8779).

Non-Network Retail Pharmacy
Your medications will cost the most at non-network retail pharmacies because they do not belong to the DoD TRRx network. At non-network pharmacies you will pay full price for your medication. To be reimbursed for non-network pharmacy claims, you must fill out a claim form (PDF file), attached the required paperwork, and mail it to:

Express Scripts
P.O. Box 66518
St. Louis, MO  63166-6518

Generic Drugs

Generic drugs are medications approved by the U.S. Food and Drug Administration (FDA) that are clinically equivalent to brand-name products. For more information about generic drugs, go to the FDA website. Ask your doctor about using generic drugs when available. Generics give the same safe, effective treatment that you get from brand-name drugs, and help you and the Department of Defense save money.

Your copayment will always be lowest when you fill a prescription with formulary generic drugs at a network retail pharmacy or through TMOP.

It is DoD's policy to substitute generic medications for brand-name medications when available. Brand-name drugs that have a generic equivalent will be dispensed only if the prescribing physician justifies medical necessity for use of the brand-name drug in place of the generic one.

If a generic-equivalent drug does not exist, the DoD TRICARE network retail pharmacy dispenses the brand-name drug at the brand-name copayment.

Using TRRx with Other Health Insurance (OHI)

Having OHI does not prevent you from using the DoD TRRx program, but there are a few guidelines and policies to follow in accordance with federal law, which says that TRICARE becomes second payer to your OHI. It is also important to provide complete, accurate OHI information when submitting paper claims to prevent delays in claims processing.

To be reimbursed for the eligible portion of your out-of-pocket expenses, submit a claim form (DD 2642) and medication receipts showing the amount your OHI contributed toward the cost of the medication to:

Express Scripts
St. Louis Claims Administration STL1421
P.O. Box 66518
St. Louis, MO 63166-6518

If you have OHI, TRICARE becomes first payer when:

  • Your OHI does not have a pharmacy benefit or is a drug discount plan.
  • The drug is not covered by your OHI, but is covered by TRICARE. To be reimbursed, you must obtain an Explanation of Benefits (EOB) from your OHI provider stating the medication is not covered and submit the EOB to Express Scripts with a claim form.
  • Coverage under your OHI is used-up for the year. You must obtain an EOB from your OHI provider stating your OHI coverage ended for the year. Submit it to Express Scripts with a claim form.

For more information, visit the OHI section of the TRICARE website or call 1.866.DOD.TRRX (1.866.363.8779).

Uniform Formulary (UF)

The UF process establishes a nonformulary copay of $22 for up to a 30-day or 90-day supply, depending on whether you use a TRRx network pharmacy or the TMOP. You may also fill your prescriptions for nonformulary medications at a non-network pharmacy, but you will pay significantly more and must meet a deductible. Patients using nonformulary medications may wish to consult with their doctor about formulary alternatives. For more information on the UF visit the TRICARE website or call 1.866.DOD.TRRx (1.866.363.8779).



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