Military families rely on TRICARE for healthcare, and prescriptions are a major part of that benefit. Express Scripts TRICARE manages pharmacy benefits for approximately 9.5 million active-duty service members, retirees, and their dependents under a contract with the Department of Defense. Whether you fill at a military pharmacy, a retail network pharmacy, or through mail order, Express Scripts processes those claims. Here is how the system works and how to get the most from your benefit.
How Express Scripts Manages TRICARE Pharmacy Benefits
The Defense Health Agency contracts with Express Scripts to administer pharmacy benefits for all TRICARE-eligible beneficiaries. This arrangement has been in place since 2009, with the current contract extended through the mid-2020s. Under this agreement, Express Scripts handles formulary management, claims processing, mail-order pharmacy operations, and the retail pharmacy network for TRICARE.
Express Scripts TRICARE operates differently from commercial PBM arrangements in several important ways. The formulary is standardized across all TRICARE plans rather than varying by employer. Copay amounts are set by federal regulation, not by individual plan sponsors. And military treatment facility pharmacies remain the lowest-cost option for beneficiaries, operating outside the Express Scripts network.
TRICARE Pharmacy Copay Structure
TRICARE copays depend on two factors: the type of drug and where you fill the prescription. As of 2026, the copay structure breaks down as follows:
Military pharmacy: $0 for all formulary medications. This is the cheapest option available, and there is no copay for generics or brand-name drugs.
Mail order through Express Scripts: $0 for generic medications, $14 for formulary brand-name drugs, and $43 for non-formulary medications for a 90-day supply. Active-duty service members pay $0 for all mail-order prescriptions.
Retail network pharmacy: $14 for generic medications, $38 for formulary brand-name drugs, and $68 for non-formulary medications for a 30-day supply. These copays apply to most TRICARE plans, though active-duty service members pay $0 at network pharmacies as well.
According to the Military Health System, copay amounts are reviewed annually and may change with each fiscal year. Always verify current rates on the TRICARE website or through Express Scripts.
Setting Up Mail Order with Express Scripts TRICARE
Mail order is strongly encouraged for TRICARE beneficiaries taking maintenance medications. The cost advantage is significant — you get a 90-day supply at mail-order prices that are substantially lower than three separate retail fills.
To set up mail order, register at the Express Scripts TRICARE website (militaryrx.express-scripts.com) or call 1-877-363-1303. You will need your Department of Defense Benefits Number (DBN), which is your Social Security Number or a DOD-assigned number, along with your date of birth and the prescription details.
Your doctor can send a 90-day prescription electronically to Express Scripts using NCPDP number 4336761. Alternatively, you can mail a paper prescription to Express Scripts at the address provided on the TRICARE pharmacy website. First orders typically arrive within 14 business days. Subsequent refills ship within 3 to 5 business days.
The TRICARE Formulary
TRICARE uses a Uniform Formulary managed by the Department of Defense Pharmacy and Therapeutics Committee. This committee, composed of military and civilian healthcare professionals, reviews medications and assigns them to one of three tiers:
Tier 1 (Generic): Generic drugs with the lowest copays. These are the preferred option whenever a generic equivalent is available.
Tier 2 (Formulary Brand): Brand-name drugs approved for the TRICARE formulary. These carry moderate copays at retail and through mail order.
Tier 3 (Non-Formulary): Brand-name drugs not on the preferred formulary. These have the highest copays. In some cases, prior authorization is required before coverage applies.
The formulary is updated quarterly. When a drug moves from Tier 2 to Tier 3, or when a new generic becomes available, your copay may change. Express Scripts notifies affected beneficiaries by mail or email when formulary changes impact their prescriptions.
Using Retail Pharmacies with TRICARE
Express Scripts maintains a retail pharmacy network for TRICARE that includes most major chains — CVS, Walgreens, Walmart, Kroger, and many independent pharmacies. Present your military ID or TRICARE card at any network pharmacy to fill prescriptions at TRICARE copay rates.
Filling at non-network pharmacies is possible but more costly. You will pay the full price upfront and submit a claim to Express Scripts for partial reimbursement. The reimbursement amount is based on the TRICARE allowable charge, which may be less than what you paid. Sticking with network pharmacies avoids this hassle entirely.
Some TRICARE plans require beneficiaries to use mail order for maintenance medications after an initial retail fill period. If your plan has this requirement, continuing to fill maintenance prescriptions at retail may result in higher copays.
Prior Authorization Under TRICARE
Certain medications require prior authorization before Express Scripts will cover them under TRICARE. This typically applies to high-cost medications, drugs with significant safety concerns, or medications where a cheaper alternative exists.
Your doctor initiates the prior authorization process by contacting Express Scripts with clinical documentation supporting the need for the specific medication. According to CMS and DOD guidelines, non-urgent requests are processed within 72 hours. Urgent requests, where a delay could seriously harm the patient, receive a response within 24 hours.
If a prior authorization is denied, you have the right to appeal. The first level of appeal goes through Express Scripts. If the denial is upheld, you can escalate to the Defense Health Agency for a formal review. TRICARE beneficiaries also have access to an independent external review process.
Specialty Medications and TRICARE
TRICARE covers specialty medications for conditions like cancer, multiple sclerosis, rheumatoid arthritis, and hepatitis C. These prescriptions are managed through Express Scripts’ specialty pharmacy, Accredo, or through military treatment facility pharmacies.
Specialty medications often have different handling requirements — temperature-controlled shipping, patient monitoring programs, and mandatory check-ins with clinical staff. Express Scripts coordinates these services for TRICARE beneficiaries at no additional administrative cost, though copays still apply based on formulary tier placement.
Frequently Asked Questions
Can active-duty service members use Express Scripts mail order?
Yes. Active-duty service members pay $0 for all prescriptions through Express Scripts mail order, regardless of whether the drug is generic, brand-name, or non-formulary. Mail order is often more convenient than visiting a military pharmacy, especially for service members stationed at installations with limited pharmacy hours.
What if my TRICARE prescription is denied by Express Scripts?
If Express Scripts denies coverage for a medication, your prescribing doctor can submit a prior authorization request with clinical justification. If the prior authorization is denied, you can appeal through Express Scripts and then escalate to the Defense Health Agency. Many initial denials are overturned with proper documentation.
Does TRICARE cover compounded medications?
TRICARE covers some compounded medications when commercially manufactured alternatives are not available or appropriate. The compound must be prescribed by a TRICARE-authorized provider and filled at a network pharmacy. Certain bulk compounding ingredients are excluded from coverage. Check with Express Scripts before filling a compounded prescription to verify coverage.
How do I check if a pharmacy is in the TRICARE network?
Use the pharmacy locator tool on the Express Scripts TRICARE website or call 1-877-363-1303. Enter your zip code to find nearby network pharmacies. Most major retail chains participate, but independent pharmacies may vary by location.
Maximizing Your TRICARE Pharmacy Benefit
The single best way to save on TRICARE prescriptions is to use military treatment facility pharmacies whenever possible — every fill is $0. When that is not practical, mail order through Express Scripts TRICARE is the next most cost-effective option, especially for maintenance medications.
Review your medications at least annually against the current TRICARE formulary. Ask your doctor about generic alternatives that could lower your copay. Set up automatic refills through Express Scripts to avoid running out of critical medications. For broader context on how pharmacy benefits work across different programs, see our healthcare policy guide and our overview of what a PBM is.