![]() ![]() Your medical necessity approval will apply at network pharmacies and home delivery.Ĭan't find the form you need? Contact Express Scripts.Search for your drug on the TRICARE Formulary Search Tool.Your authorization approval will apply to military pharmacies, network pharmacies, and home delivery.Ĭan't find the form you need? Contact Express Scripts.Give the form to your provider to complete and send back to Express Scripts.Download and print the form for your drug.Search for your drug on the TRICARE Formulary Search Tool Is prescribed for an amount more than the normal limitĬheck the TRICARE Formulary to see if you need pre-authorization.Is a brand-name prescription drug with a generic substitute.Is specified by the DoD Pharmacy & Therapeutics Committee.You may need pre-authorization for your prescription if it: Medically necessary To be medically necessary means it is appropriate, reasonable, and adequate for your condition.We use it to make sure your prescription drug is: If the requested drug also requires prior authorization, your doctor should submit a prior authorization request as well.Get Pre-Authorization or Medical Necessity Your doctor can request a co-pay reduction on your behalf by completing and submitting a non-formulary co-pay reduction request form. If your doctor can establish that you are not able to be treated with generic or preferred formulary brand medications, you can get non-formulary drugs at a network pharmacy, or through home delivery. If your medical condition warrants a larger quantity of your medication than the listed quantity limit, your doctor should submit a prior authorization request. ![]() Quantity limits are established for certain drugs to ensure the medication is being used correctly. In case the medication is not listed, your doctor may use the non-drug specific prior authorization form. Your doctor must complete and fax the prior authorization form for the specific medication to the Johns Hopkins HealthCare Pharmacy department at 41. When medically necessary, your doctor can request an exception to the step therapy requirement. Non-preferred drugs are only prescribed if the preferred medication is ineffective or poorly tolerated.ĭrugs subject to step therapy will be approved for first-time users only after they have tried one of the preferred agents as covered in the TRICARE formulary. The preferred prescribed medication is often a generic version that offers the best overall value in terms of safety, effectiveness, and cost. Step therapy is a process where we look for ways to provide our members the most cost-effective medication that is safe and clinically effective for their condition. If you or your provider have a copy of the previous approval letter, please fax it along with the Prior Authorization Form to USFHP. Please note: If another Health Plan or Tricare has previously approved a medication, USFHP will not have access to that information. To initiate a prior authorization, your doctor must complete and fax the prior authorization form for the specific medication to the Johns Hopkins HealthCare Pharmacy department at 41. This helps us ensure that your prescriptions are medically necessary.įor a list of drugs that require prior authorization, refer to the TRICARE Prior Authorization page. Some medications require prior authorization from our plan before they can be dispensed by your pharmacist. The formulary is updated on a regular basis to include tier changes and utilization (UM) requirements. Registration is required for first-time users. You can also find information about medications, including how to take them, possible side effects, and drug interactions. Use the TRICARE formulary search tool to find coverage and cost share details for a specific drug. Each of these tiers represents a cost share that USFHP members are responsible for paying. It is a tiered, open formulary, and includes generic drugs (Tier 1), preferred brand drugs (Tier 2), and non-preferred brand drugs (Tier 3). The formulary lists all of the prescription drugs that are covered under the TRICARE benefit. ![]() ![]() Johns Hopkins USFHP utilizes the TRICARE ® pharmacy formulary. ![]()
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