Home

Benefit Summary

Advantages of TRRx

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


  • The retail pharmacy benefit is available to eligible beneficiaries wherever the DoD TRRx network exists - across all TRICARE regions.


  • 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 your prescriptions through one database, the Pharmacy Data Transaction Service (PDTS), which helps ensure your safety.

To get medications, you can use a network of approximately 55,000 retail pharmacies in the United States and its territories, or you can choose TRICARE's Mail Order Pharmacy (TMOP) service.

Eligibility

All TRICARE-eligible beneficiaries who live within the United States, Puerto Rico, the U.S. Virgin Islands, and Guam may use the DoD TRRx Program. The program is not available in other overseas locations.

You need to 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 "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 TTY/TDD for the Hearing Impaired at 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 (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.

Note: You must have Adobe® Acrobat® Reader® to print the claim form.

Copayment Information

The cost of your medication, established by TRICARE, varies according to the type of drug (brand name or generic) 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		 Generic Drugs
(Tier 1)		 Formulary Drugs
(Tier 2)		 Non-Formulary Drugs
(Tier 3)
Military Treatment Facility (MTF) $0 $0 Not Applicable
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 medication
at a non-network retail pharmacy
and then submit a claim
(DD Form 2642) for reimbursement.		 TRICARE Standard Beneficiaries
$9 (or $22 for non-formulary) 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 members using an MTF pharmacy, the TMOP program or a DoD TRRx network pharmacy.

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 the TMOP or a network retail pharmacy.

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: An Express Scripts pharmacist fills your prescription and double-checks your order for accuracy. You receive your medication in a weather-resistant pouch for your privacy and protection.
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.

    Note: You must have Adobe® Acrobat® Reader® to print the registration form.

  3. Mail your prescription and completed mail order registration to the address shown on the form.

For more details, please visit the TMOP website or call toll-free, 1.866.363.8667.

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

To find a TRICARE network retail pharmacy near you, please use the Pharmacy Locator or 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. To get reimbursed for non-network pharmacy claims, you need to fill out a claim form and mail it to:

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

Note: You must have Adobe® Acrobat® Reader® to print the claim form.

Generic Drugs

It is DoD's policy to substitute generic medications for brand-name medications when available. Beneficiaries who wish to take a brand-name drug when a generic is available must choose from the following options:

  • Pay 100% of the cost of the drug at the pharmacy.
  • Ask the doctor to contact Express Scripts TRRx Prior Authorization department by phone at 1.866.684.4488 or fax 1.866.684.4477. The doctor will need to justify why it is medically necessary to receive the brand-name drug instead of the generic version.

Please note: Beneficiaries that began taking a brand-name drug between December 1, 2003, and June 1, 2004, are allowed to continue taking that brand-name drug until December 12, 2004.

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, visit 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 generic drugs at a TRICARE network retail pharmacy or through the TMOP service.

If a generic equivalent drug does not exist, the 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 TRICARE Retail Pharmacy (TRRx) Program. TRICARE typically becomes the second payer in these situations. TRICARE becomes the first payer when:

  • The drug is not covered by your OHI, but is covered by TRICARE.
  • Coverage under your OHI is used up for the year.
To get reimbursed for a portion of your out-of-pocket expenses:
  1. Print and complete a claim form.
  2. Attach any medication receipts that show OHI payment.
  3. Mail the above documents to:

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

Note: You must have Adobe® Acrobat® Reader® to print the claim form.

Please note that supplemental and discount prescription drug programs, such as AARP, Senior Friends, or Medicare, do not count as OHI pharmacy coverage. In these cases, TRICARE pays as primary, and you will be charged the appropriate copay. If you are submitting for reimbursement on one of the few items covered under Medicare Part B, please indicate "OHI" on your claim form.

For more information on the impact of OHI, please contact Express Scripts at 1.866.DOD.TRRx (1.866.363.8779) or visit the TRICARE website and search for the term "Pharmacy OHI".