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By TRICARE Communications
/ Published August 16, 2022
Some options under the TRICARE Pharmacy Program will require you to submit a claim, so it’s important to understand the claims process.
When you use the TRICARE Pharmacy Program benefit, you may wonder if you must file claims for reimbursement for prescription drugs. Here’s an overview of when and how to successfully file pharmacy claims.
“The TRICARE Pharmacy Program is a comprehensive pharmacy benefit, which offers a number of efficient and cost-effective ways to fill your prescription drugs,” said U.S. Public Health Service Cmdr. Teisha Robertson, a pharmacist with the Defense Health Agency’s Pharmacy Operations Division. “In most cases, you won’t have to file pharmacy claims. However, some pharmacy options will require you to submit a claim, so it’s important to understand the process.”
When you don’t need to file a claim
If you’re like most beneficiaries who get your prescription drugs filled at a military pharmacy, through TRICARE Pharmacy Home Delivery, or at a TRICARE retail network pharmacy, you don’t need to file a claim.
When you need to file a claim
Under the TRICARE Pharmacy Program, which Express Scripts administers, you’ll need to file a claim for prescription drugs if:
In all cases, though, you must file your claim with TRICARE within one year from the date you filled your prescription.
How to file a claim if you live in the U.S. or U.S. territories
You have two options: submit a claim online or file a paper claim.
It’s easy to submit a claim electronically:
You’ll need to upload and include images of your:
Keep in mind, you can submit an online claim if you’re coordinating benefits or if the prescription drug:
If you prefer to submit your claim through the mail, follow these steps:
How to file a claim if you’re overseas
If you fill a prescription overseas, file your claim with your TRICARE Overseas Program claims processor to be reimbursed on covered prescription drugs. You can do this either online through the secure claims portal or by mail. Be sure to submit proof of payment with your overseas pharmacy claims. If you’re in the Philippines, you must get your prescription filled at a TRICARE-certified pharmacy to ensure your claims are reimbursed.
Download the TRICARE Pharmacy Program Handbook for everything you need to know about your pharmacy benefit and claims filing. For a quick overview, watch this video on claims filing. You can also reach out to Express Scripts 24/7.
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