Covered Services

When visiting non-network pharmacies, you pay the full price of your medication up front and file a claim to Express Scripts for reimbursement. Reimbursements are subject to deductibles, out-of-network cost-shares, and TRICARE-required copayments. All deductibles must. A nominal copay may apply. New Prescriptions from Madigan Providers. If your provider is located at Madigan (virtual visit or in-person visit), contact our Pharmacy Call Center at 253-968-2586 to inquire if your prescription has been received by the pharmacy. Please Be Aware: In accordance with TRICARE Express Scripts policy.

1. Express Scripts Pharmacy® will process your prescription and mail it to you. If a copayment applies, you’ll receive an invoice in the mail. Your doctor can submit prescriptions directly to us through the electronic medical record (EMR) at: Express Scripts Home Delivery Pharmacy, 4600 North Hanley Road, St. Louis, MO 63134.
2. The TRICARE Pharmacy Program, administered by Express Scripts, is designed to provide the medications beneficiaries need, when they need them, in a safe, convenient and cost-effective manner.

TRICARE covers most prescription drugs approved by the U.S. Food and Drug Administration (FDA). Prescription drugs may be available as part of the pharmacy or medical benefit.

For a drug to be covered by the TRICARE pharmacy benefit, it must:

1. Be approved by the FDA
2. Not be part of a procedure covered under the medical benefit
3. Be prescribed in accordance with good medical practice and established standards of quality

TRICARE doesn't cover drugs that aren't medically or psychologically necessary for the diagnosis or treatment of a covered illness.

This list of covered services is not all inclusive. TRICARE covers services that are medically necessaryTo be medically necessary means it is appropriate, reasonable, and adequate for your condition. and considered proven. There are special rules or limits on certain services, and some services are excluded.

These are the drugs you get while you’re hospitalized or during an outpatient visit.

Tricare Drug Copays

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Express Scripts Tricare Copay 2020