Frequently Asked Questions
	Question Categories Active Duty Service Members Deployed Service Members Medicare Part D and TMOP Benefit Coverage Uniform Formulary Mail Order Prescriptions Generic Drugs Website Security Contact Express Scripts

When I place my prescription order, am I required to provide my credit card information if I am on active duty?
No, credit card information is required only for beneficiaries who are ordering online and are not on active duty, or for any beneficiary who requests expedited shipping of a prescription order.

How do deployed service members update their mailing address with TMOP?
You can update your address online. Just log on to (or activate) your online account with Express Scripts. After logging on, follow the prompts to update your Patient Information.

When I place my prescription order, am I required to provide my credit card information if I am on active duty?
No, credit card information is required only for beneficiaries who are ordering online and are not on active duty, or for any beneficiary who requests expedited shipping of a prescription order.

I’ve recently been deployed. Why can’t I view the status of my refill from TMOP?
When service members are deployed, they receive an initial supply of medication from a Military Treatment Facility (MTF). Their next supply of this medication is provided through TMOP and is considered a new prescription, rather than a refill.

TMOP receives this new prescription approximately 45 days before the service member’s initial supply from the MTF will run out. After TMOP receives the new prescription, status information will be visible through the View Status feature of your online account with Express Scripts.

If I have coverage under a Medicare Part D program and TRICARE, can I still use TMOP?
Unfortunately, at this time you may not use TMOP. However, you can still use TRICARE as your secondary insurance through your local TRICARE retail network pharmacy.

My prescription was processed under my Medicare Part D plan. Can I also submit the prescription as a secondary claim to TRICARE?
Yes. Most local TRICARE retail network pharmacies can immediately submit electronic claims to TRICARE as secondary insurance when you obtain your medication.

You may also submit paper claims by including a copy of your Medicare Part D Explanation of Benefits, along with a claim form DD2642 (PDF file) , to:

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

I received a letter stating that I currently have coverage under a Medicare Part D program, but I don't remember signing up. How can I use my TRICARE benefit instead?
You can cancel your enrollment in the Medicare Part D program by contacting your Medicare plan vendor. If you do not know the name of your plan, you can call Medicare directly at 1.800.633.4227.

Your Medicare plan will send you a proof of disenrollment notice. You should provide this notice to DEERS to update your record, thereby allowing you to use your TRICARE benefit.

A copy of your disenrollment paperwork can be mailed or faxed along with a letter request to:

DSO
400 Gigling Road
Seaside, CA 93955-6771

Fax: 831.655.8317

Updates will be completed within 2-4 business days, after which you may send in your prescription request to Express Scripts.

I cancelled my Medicare prescription plan in order to use my TRICARE benefit. However, my new prescription order with Express Scripts still rejected. Why?

When you cancel your Medicare Part D program, you must provide proof of disenrollment to DEERS to update your record, thereby allowing you to use your TRICARE benefit.

A copy of your disenrollment paperwork can be mailed or faxed along with a letter request to:

DSO
400 Gigling Road
Seaside, CA 93955-6771

Fax: 831.655.8317

If you have already provided notice of your disenrollment to DEERS and more than four business days have passed, please contact us so that we can research your account further.

What are the advantages of using TMOP?
If you take prescription drugs for long-term, ongoing conditions, using TMOP and Express Scripts can help you save both time and money.

Note: If you need a prescription immediately or for one-time use (antibiotics, for instance), go to a Military Treatment Facility or TRICARE network retail pharmacy.

Convenient

• You can fill your new prescriptions by mail, and you can order refills by mail, phone or online.
• Standard shipping and handling are free. You can request expedited shipping for an additional charge.
• Your prescriptions are mailed to any U.S. postal address, including temporary addresses, APO and FPO. If you are assigned to an embassy and do not have an APO/FPO address, you must use the embassy address.

Safe

• Registered pharmacists verify your order twice for accuracy and safety.
• Your prescriptions are checked against your medication profile through a direct link to the Department of Defense (DoD) Pharmacy Data Transaction Service (PDTS). PDTS holds records of all prescriptions processed from Military Treatment Facilities, TRICARE retail network pharmacies and the TRICARE Mail Order Pharmacy.
• Your medications are shipped in plain, weather-resistant pouches for your protection and privacy.
• If you have questions about your prescription drugs, a registered pharmacist is available to talk to you at any time.

Economical

• You can order up to a 90-day supply of your medication for the same copayment as a 30-day supply at a retail pharmacy. That’s a 66% savings for you.

If I use the TMOP program, can I still use the Military Treatment Facility (MTF) and retail pharmacies?
Yes. Using TMOP does not prevent you from using MTF pharmacies or pharmacies in the TRICARE Retail Pharmacy (TRRx) network. In fact, using an MTF pharmacy is recommended because it's the most cost-effective way — both for you and the DoD — to get prescription drugs. You should also use an MTF or network retail pharmacy for prescriptions you will take only once or need to begin immediately, such as an antibiotic.

Can I use TMOP even if I have other health insurance coverage with a prescription drug benefit from another source (for example, my current employer or my spouse’s employer)?
No. If you are covered by other health insurance (OHI) with a prescription drug benefit, you may not use TMOP unless the other plan does not cover the medication needed or you have exceeded the dollar limit of coverage under that other plan.

• If the medication needed is not covered by OHI, submit the prescription and the Explanation of Benefits from the OHI to Express Scripts. If the drug is covered by TMOP, Express Scripts will fill the prescription.
• If you reach your OHI’s benefit cap, submit a copy of the cap notice to Express Scripts with your prescription. If the drug is covered by TMOP, Express Scripts will fill the prescription until your OHI prescription drug benefit is renewed.

Can I submit prescriptions written by any doctor?
By law, only prescriptions written by prescribers licensed in the United States, District of Columbia or a U.S. territory are considered valid. For controlled substances, the prescriber must provide his or her individual DEA number. Prescribers cannot write prescriptions for family members.

Are National Guard/Reserve personnel and their families eligible?
National Guard/Reserve personnel and their family members are eligible to use TMOP if the sponsor is on Title 10 or Title 32 (federal) active duty orders for more than 30 days. Coverage begins the day the sponsor's orders begin for both the member and his or her family members.

As a National Guard/Reserve member on Title 10 (or 32) orders for 120 days, how do I ensure coverage?
Your DEERS records must show activated status for you. To verify your eligibility status, contact DEERS before deployment, if possible, using the information below. Changes need to be made in person at the nearest ID card issuing facility.

DMDC Support Office (DSO) — 800.538.9552
Online — www.tricare.osd.mil/deers

Are National Guard/Reserve personnel who were on Active Duty under Title 10 and have been discharged from active duty entitled to coverage for TMOP and TRRx under the TRICARE Reserve Select (TRS) Program?
These personnel are entitled to coverage if they meet the criteria for the TRS program.

What is a formulary?
A formulary is a drug list that helps determine your copayment for each prescription. In most cases, you'll pay a lower copayment for the drugs on the formulary.

How do I find out if the drug I need is on the formulary, has a prescribing restriction, or requires prior authorization?
Visit the TRICARE website to read the TMOP formulary and coverage requirements/limitations.

Do some prescription drugs cost more or have additional requirements for coverage?
Yes. Some drugs are considered nonformulary medications. These drugs are covered for a copayment of $22. Your doctor can submit evidence of medical necessity for these drugs, and if the evidence of medical necessity is approved, your copayment will be only $9. The TRICARE website provides more information about medical necessity for nonformulary medications.

Other drugs are covered only if you receive prior authorization. These drugs require evidence of medical necessity by the health care provider who prescribed the medication. If the evidence of medical necessity is approved, your copayment will be $9 for these drugs. The TRICARE website provides more information about prior authorization requirements.

Why is a medication not included on the formulary?
Some medications are excluded from the formulary (that is, they are not available under the TMOP program) in order to help control your overall healthcare costs.

The TRICARE website provides general formulary information, including a list of drug categories that are excluded from your mail order benefit. You can also get more information on a particular excluded drug by viewing the TMOP formulary and coverage requirements/limitations.

What is a copayment?
A copayment is a fixed-dollar amount paid by a beneficiary for a prescription drug. The copayment cost is determined by the drug coverage guidelines of the TMOP program. Copayments are the most common form of out-of-pocket expense for prescription drugs. You can use the TRICARE website to view specific copayment information for your medication.

What is the Uniform Formulary?
On 1 April 2004 TRICARE announced the Uniform Formulary Final rule. This rule outlines requirements for a new formulary process and copayment structure called the “Uniform Formulary” under the direction of the 2000 National Defense Authorization Act, Section 701.

As part of this new process, the DoD Pharmacy & Therapeutics (P&T) Committee, composed of pharmacists and doctors, reviews and evaluates FDA-approved prescription medications to determine their relative clinical and cost effectiveness. The committee then recommends whether a drug should be considered generic, formulary, or non-formulary.

Drugs that are equally effective but cost more compared to other drugs in the same class may be recommended for placement in the non-formulary category.

Previously, most medications were grouped into two categories: generic or brand name. Under the new process, any drug placed into the third category (non-formulary) will be available to beneficiaries at a higher copayment.

Effective 17 July 2005, the new copayment structure under the Uniform Formulary is as follows:

• Generic: $3
• Formulary: $9
• Non-Formulary: $22

How can I find out which drugs are considered non-formulary?
On 17 July 2005 TRICARE announced the first three non-formulary medications: Nexium, Teveten and Teveten HCT.

New additions to the non-formulary drug list will be posted on the Non-Formulary Medications section of the TRICARE website. You can also use the TRICARE formulary tool to verify formulary status before sending in your prescription.

How can I continue paying $9 for my non-formulary medication?
If you are taking a non-formulary medication, you may wish to talk with your doctor about formulary alternatives. To review therapeutic alternatives to non-formulary drugs, visit the Uniform Formulary section of the TRICARE website.

In addition, you may be able to obtain your non-formulary medication for $9 if your doctor believes it is medically necessary for you to use the non-formulary medication instead of a formulary alternative. In this case, your doctor will need to submit a medical necessity form (available from the Non-Formulary Medications section of the TRICARE website). Your doctor should then submit the form and prescription using one of the following options:

• Fax to Express Scripts toll-free at 877.283.8075 (overseas doctors use 602.586.3915)
• Mail to:
  Express Scripts
  PO Box 52150
  Phoenix, AZ 85072.

If approved, future refills of your non-formulary medication will be charged at the $9 formulary copayment. Please note that an approval notification will not be sent to you.

Once medical necessity is established, will my approval expire?
No. After medical necessity is established, the approval will be valid for as long as you require the medication.

If I obtain medical necessity for a non-formulary drug under the mail order program, will the same override work at a retail pharmacy?
Yes. Even though medical necessity should be established under the program in which you plan to fill your prescription, the override will work in both the mail order and the retail programs.

My prescription and medical necessity form have been sent to Express Scripts. How will I know if medical necessity approval was granted?
If the form was approved, your prescription will be processed at the $9 formulary copayment and shipped to you. If denied, you will receive a notification letter.

You may also check the status by calling the Patient Care Contact Center, which is open 24 hours a day. A patient care advocate will be happy to provide you with an update if one is available. Please allow approximately three days if faxed or seven days if mailed before calling the Contact center.

If I previously obtained medical necessity approval for a non-formulary medication, will it be grandfathered?
No. If you previously obtained a medical-necessity approval before the medication was considered non-formulary, you will be required to reestablish medical necessity under the new criteria approved by the Director of TRICARE.

I am on Active Duty. Will I have to pay $22 for a non-formulary medication?
Active duty service members may not fill prescriptions for a non-formulary medication unless it is determined to be medically necessary by the prescribing doctor first. Prescriptions received for non-formulary medications without evidence of medical necessity are returned to the patient. If medical necessity is approved for the active duty beneficiary, there will be no copayment ($0) charged.

If I am on Active Duty and do not wish to obtain medical necessity approval, can I pay the copayment of $22 and obtain the non-formulary medication anyway?
No. Under the Uniform Formulary regulations, active duty service members cannot obtain a non-formulary medication unless medical necessity is substantiated.

Doctors can begin the medical necessity process by submitting a medical necessity form (available from the Non-Formulary Medications section of the TRICARE website). The doctor should submit the form and prescription using one of the following options:

• Fax to Express Scripts toll-free at 877.283.8075 (overseas doctors use 602.586.3915)
• Mail to:
  Express Scripts
  PO Box 52150
  Phoenix, AZ 85072.

If I meet my Catastrophic Cap requirement for the year, will I still be charged a copayment for a non-formulary medication?
No. After your cap is met, no copayments will be charged for your medications until the following fiscal year (beginning October 1).

The medication I received is a generic, but I was charged $22. Why?
Occasionally, some medications that are classified as generics may be considered non-formulary. Non-formulary generics will be subject to the non-formulary copayment of $22 without medical necessity approval, and $9 with medical necessity approval.

How do I start using the TRICARE Mail Order Pharmacy (TMOP) program?
It’s easy. Just follow the instructions below:

• To get started by placing an order, log on to your account and use the Fill a New Prescription feature to print a prescription order form. You can then mail your order form and your written prescription to the address shown on the form.
• To get started without placing an order, log on to your account and use the Patient Information feature to submit your information to TMOP. By providing this information in advance, you will expedite the processing of your first order.

Where can I get a prescription order form?
You can get an order form using any of the following options:

• Print the TMOP Mail Order Registration Form.
• Print an order form using the “Fill a New Prescription” feature at Express-Scripts.com.
• Pick up an order form at any Military Treatment Facility.
• Call Express Scripts toll-free at 866.DOD.TMOP (866.363.8667). Select the option to leave your name and address, and we’ll mail an order form to you.

Note: You must have Adobe® Acrobat® Reader® to print the TMOP Mail Order Registration Form.

What information is needed for each new prescription?
Make sure the following information is included on each prescription (any missing information should be written on the back).

• The patient's full name, date of birth and address
• The sponsor's Social Security number
• The prescriber's name, address, phone number and DEA number

Be sure all patient and prescriber information is legible. A reference to your time zone is helpful, especially if you are overseas.

If your doctor is faxing your prescription, please ensure that:

• The office does not use colored prescription pads, as they do not fax clearly.
• The office clearly identifies the doctor who wrote your prescription.
• The office clearly identifies that the fax is coming directly from their office (by law, faxed prescriptions can be accepted from doctor’s offices only).

All of these measures will help ensure that your prescription is received and processed in a timely manner.

How do I submit my new prescription?

Order by mail: Send your order form and the written prescription provided by your doctor to:

Express Scripts, Inc.
P.O. Box 52150
Phoenix, AZ 85072

Order by phone: Have your doctor call Express Scripts toll-free 877.283.3858.

Order by fax: Have your doctor fax your order form and your written prescription to Express Scripts using the following information:

If your doctor is faxing your prescription, please ensure that:

• The office does not use colored prescription pads, as they do not fax clearly.
• The office clearly identifies the doctor who wrote your prescription.
• The office clearly identifies that the fax is coming directly from their office (by law, faxed prescriptions can be accepted from doctor’s offices only).

All of these measures will help ensure that your prescription is received and processed in a timely manner.

How long will it take to get my prescription order?
You can expect your order to arrive at your U.S. postal address within 14 days. To make sure you receive your refills before your current supply runs out, re-order at least two weeks before you need your refill — and you may want to allow a few extra days for APO/FPO delivery.

How do I refill a current prescription using the TMOP program?

Order Online
You can order refills quickly and easily using your online account. Payment by check card or credit card is required unless you are an active duty member.

Order by Phone
Quickly order refills using the toll-free number on your prescription bottle. Payment by check card or credit card is required.

Order by Mail
When you fill your prescription with Express Scripts, a refill form is included with your first shipment. Use the envelope provided to mail the refill form to Express Scripts. You should mail your refill form about three weeks before your current supply will run out. If you mail your form before then, your order may be delayed. Please also make sure your prescription has not expired.

Include your payment with your order. For your convenience and to ensure delivery of your prescription without delay, you are encouraged to provide your check card or credit card information on your refill form. Express Scripts accepts Visa, MasterCard, Discover and American Express. Your check card or credit card account will be billed automatically upon processing your order. If you have not provided your card information, you may enclose a personal check or money order for your payment amount.

Your last refill will include a renewal label with instructions for receiving future refills of your medication.

Note: A complete street address is required for controlled substance medications, and an adult signature is required upon receipt.

Where will my prescription order be delivered?
Your order will be mailed to any U.S. postal address, including temporary addresses, APO and FPO. If you are assigned to an embassy and do not have an APO/FPO address, you must use the embassy address. Orders cannot be mailed to a private foreign address.

Are delivery confirmation services available for my shipment?
Delivery Confirmation and Signature Confirmation are available under the following conditions:

Can I request expedited shipping for my prescription order?
Yes, but please note that you will be charged $18 per order for any type of expedited shipping, and that each family member’s medications are shipped as separate orders. Therefore, if you order medications for three different family members and request expedited shipping for all of those medications, your shipping costs would total $54 ($18 X 3 orders).

Please note that expedited shipping is not available for APO/FPO addresses.

To expedite the shipping of a prescription order, please contact Express Scripts.

What do I do if I have more than one address?
To add an address or change addresses, call 866.DOD.TMOP (866.363.8667). A patient care advocate will help you.

After I place an order, how do I check on its delivery status?
You can check on the status of your order anytime using your online account or by calling toll-free, 866.DOD.TMOP (866.363.8667). Please note that if your prescription requires additional research (for example, if a pharmacist has to contact your doctor for more information), your order may not appear on your online account until the research is completed.

If my prescription is NOT a compound or controlled medication, do I have to speak with a patient care advocate to order a refill?
No. While you can always order refills from an advocate, you can also order refills through Express Scripts’ Integrated Voice Response system (IVR) at 866.DOD.TMOP (866.363.8667) or through your online account.

What if I am told that Express Scripts cannot fill my prescription because it is being refilled too early?
You may refill your prescription after you have used 67% of your medication. If you send in your refill before the allowable refill date, Express Scripts will either:

• Hold the prescription for up to 90 days and fill it on the allowable refill date, or
• Return the prescription to you if it cannot be filled within 90 days of the allowable refill date.

To avoid delays in processing, we encourage you wait to order your next refill until you have about a three-week supply of medication left.

I live apart from my sponsor. Can I establish a separate account?
Yes. Call 866.DOD.TMOP (866.363.8667) to arrange for a separate account.

How do I cancel or return an order?
To cancel or return an order, please contact Express Scripts for instructions and refund or replacement guidelines. There are specific requirements that must be met before an order can be approved for return and/or credit.

Who do I contact with billing questions?
If you have billing questions, please contact Express Scripts, and a patient care advocate will be happy to assist you.

Can Express Scripts dispense medications that need to be refrigerated?
Yes. Express Scripts will ship medications requiring refrigeration in cold packs. Please note that refrigerated medications cannot be shipped to APO/FPO addresses.

What if I have other special requests — I need extra bottles, for example?
Just ask. Include a note about your request with your order.

Can I get my prescription in a bottle without a childproof cap?
Yes. When completing your order form, just specify the type of bottles you prefer.

What are generic drugs?
A generic drug is a chemically equivalent, lower-cost version of a brand-name drug. The generic version becomes available when the brand-name drug's patent protection expires, and it usually costs about half the price of the brand-name version.

All drugs have a generic name. When a pharmaceutical company first develops a new drug, it gives the drug a generic name (or "chemical name"). The company then gives the drug a brand-name as part of its marketing plan.

What is "generic substitution"?
Generic substitution occurs when a prescription is written for a brand-name drug but is filled with a generic version.

Does the TMOP program require generic substitution?
Yes. The TMOP program is a generic-based pharmacy service. Brand-name drugs for which a generic equivalent is available may be dispensed only if your doctor submits documentation of medical necessity to Express Scripts for prescribing the brand-name drug in place of its generic equivalent. All generic drugs dispensed through the TMOP program meet the stringent standards of the U.S. Food and Drug Administration (FDA) for quality and therapeutic efficacy.

Are generic drugs tested as thoroughly as the brand-name versions?
Yes and no. To be considered a generic version, the drug must behave chemically identical to the brand-name version, which was already subjected to years of testing. The generic therefore does not have to complete the clinical trial process applied to the original drug. Nevertheless, generic drugs are tested thoroughly to make sure their performance and ingredients meet the FDA's equivalency standards.

In addition, FDA scientists sometimes visit the laboratories of the company that has applied to manufacture a generic drug. The scientists check the purity of the ingredients and the quality of the processing. The generic version must also be labeled with the same information as the original drug, including warnings and side effect information.

Are there reasons to stick with a brand-name drug even if there is a generic on the market?
In some cases, the generic version might not be right for you. Remember, the FDA regulates the equivalency of active ingredients in generic drugs. But there are also tiny amounts of inactive ingredients, which may give the drug its bulk or a specific shape or color. For some people these inactive ingredients may have an unanticipated effect.

For example, suppose you're allergic to wheat. If a drug has some added fiber to help it pass through the gastrointestinal system quickly, that fiber doesn't affect how the drug works on your arthritis pain. However, if the bulking agent is wheat fiber, you may experience a slight allergic reaction.

If you have a specific allergy, ask your pharmacist about the ingredients in your medicine and remind your doctor of your allergies. There are sometimes several generic versions of a drug with slightly different inactive ingredients, so there may be one that is right for you.

What about the companies that make generic drugs? Are they as trustworthy as the companies that make the brand-name drugs?
That's a common concern, but you can trust generic drug manufacturers. Many times the same company that developed the brand-name drug releases a generic version when the patent expires. Other companies specialize in making generic drugs.

Many drugs are difficult to make, even when their active ingredients are known. In fact, some drugs never become available as generics because they are too difficult or costly to make.

Why aren't all prescription drugs available in a generic version?
When a company develops a new drug and submits it for FDA approval, a 17-year patent is issued. A generic version cannot be manufactured until the 17-year patent expires.

In some cases, a drug is on the market for only a few years before the generic is available. This is usually because the original testing period required by the FDA took so many years that, by the time the drug was approved, there were only a few years left on the patent.

Why do some generic drugs look different than their brand-name versions?
All drugs — brand-name and generic — have inactive ingredients (such as dyes, fillers and preservatives) that often determine the size, shape and color of the drug. The inactive ingredients in a brand-name drug may be different than those used in the generic versions.

Why do I need to provide personal information during the online account activation process?
To correctly identify you and your family members, Express Scripts must obtain beneficiary-specific personal information. In most cases, only you would have access to this information. These requirements help ensure the security of your health information.

How does Express Scripts ensure that my Internet transactions are secure?
Express Scripts has enacted certain security measures (Secure Socket Layers [SSL], 128-bit encryption) to ensure the security of your personal and check card or credit card information. The SSL application is managed by VeriSign, an industry leader in authentication and security technology.

You can ensure that the environment is secured by locating the padlock icon at the bottom right hand of your screen; in addition, the website address should start with https:// (the "s" indicates that the environment is secured).

In addition to these measures, Express Scripts separates your check card or credit card information from the rest of your order data. We then store your card information on a separate server that is not accessible from the Internet to prevent external parties from viewing your information.

Is my information safe?
Yes, your privacy and the security of your personal information are of the utmost importance to Express Scripts. We will not sell or disclose your personal or health-related personal information to other companies or organizations outside of the Express Scripts companies. Read our Privacy Promise for more details.

To ensure the security of your information, our websites support 128-bit encryption. To take full advantage of this security, your Web browser must also support 128-bit encryption. For more information, read our instructions for updating your browser.

What recourse do I have if it is determined that I suffer a financial loss due to someone stealing my information from Express Scripts?
While Express Scripts takes great care in trying to prevent these types of incidents, each beneficiary accepts the user agreement during registration, which indicates the extent of Express Scripts’ liability. This agreement states the conditions under which the beneficiary does business with Express Scripts via the Internet. Specifically, the user agreement states that Express Scripts will do all that can reasonably be expected to protect beneficiary information; in addition, Express Scripts makes various recommendations with which beneficiaries should be familiar to help ensure privacy.

How can I contact Express Scripts?
For fast and friendly assistance, please contact Express Scripts using the information below.