Important Pharmacy Information

CVS/caremark Prescription Reimbursement Claim Form

Department of Defense Formulary Search Tool
The TRICARE formulary is a list of medications that are covered under the Martin’s Point US Family Health Plan benefit.  The formulary is established by the DoD Pharmacy & Therapeutics (P&T) Committee. Use this search tool to find information about what medications are covered under your pharmacy benefit.

TRICARE encourages the use of generic prescription drugs. Generics have the same high quality, potency, and reliability as brand name drugs at a much lower cost.
Important Pharmacy Information
These categories follow industry standards. They depend on the medical effectiveness and cost effectiveness of a drug compared to other similar drugs.

Newly released to market drugs
It is rare but possible to have differences in the search tool and coverage of your prescription drug.  This will happen when your prescription medication is newly released to market, and the P&T committee has not yet made a coverage decision.  The plan will make a formulary coverage decision based on clinical and financial determinations. When the DOD P&T committee makes a determination the plan will then adjust the coverage, if it is different than the DOD P&T committee decision, to match the P&T decision

Non-formulary Drug List
Non-Formulary medications as well as the criteria for Medical Necessity are established by the DoD P&T Committee.  If you meet the criteria for Medical Necessity, you may receive the Non-Formulary medication at a lower cost share.  Have your provider call 1-888-674-8734 to start the authorization process. Please refer to the formulary search tool to check that your medication is on the formulary. 

Medications Requiring Prior Authorization
Some medications require a prior authorization before they can be dispensed.  Obtaining this authorization is necessary before the prescription can be paid for by the US Family Health Plan. Please refer to the formulary search tool to check that your medication requires prior authorization. 
Call Member Services at 1-888-674-8734 or talk to your doctor for more information.

Medications Requiring Step Therapy
Step Therapy is used to provide safe, clinically effective and cost-effective medication in drug categories that have multiple agents with comparable therapeutic efficacy.  Generic drugs are commonly used as the preferred medication due to their established safety and efficacy for treating a given condition. This means that these medications are only covered if you have already tried certain medications and those did not work. Please refer to the formulary search tool to check that your medication requires Step Therapy. Call Member Services at 1-888-674-8734 or talk to your doctor for more information.

Drug Information, Side Effects, Drug Interactions
Use this search tool for information regarding a medication you are taking, including side effects or drug interactions.

Non-Covered Medications

  • Excluded drugs listed in the Non-Covered Category
  • Drugs prescribed for cosmetic purposes
  • Fluoride preparations
  • Food supplements
  • Homeopathic and herbal preparations
  • Multivitamins (some prenatal vitamins are covered with a prescription)
  • Over-the-counter products (except insulin and diabetic supplies) 
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