TRICARE Formulary Guide: 2026 Drug Tiers & Costs | TRICARE.com

The TRICARE Formulary is a searchable list of brand-name and generic drugs that TRICARE covers. Managed by Express Scripts, it categorizes medications into "tiers" that determine your out-of-pocket cost and whether you need a prior authorization or must try a cheaper drug first (step therapy).

*Disclaimer: TRICARE.com is an independent reference site and is not the official TRICARE program. For official policy and the most current drug search tool, visit TRICARE.mil.*

In detail

The TRICARE Formulary is not a static list; it is updated quarterly by the Department of Defense Pharmacy and Therapeutics (P&T) Committee. Medications are grouped into four cost-sharing tiers. Generally, as you move from Tier 1 to Tier 3, your copayment increases.

The Four Drug Tiers (2026 Rates)

| Tier | Category | Description | 2026 Copay (Home Delivery - 90 day) | 2026 Copay (Retail - 30 day) | | :--- | :--- | :--- | :--- | :--- | | **Tier 1** | Generic | Drugs with the same active ingredients as brand names. | ~$13 | ~$16 | | **Tier 2** | Brand-Name (Preferred) | Drugs that are effective but have no generic equivalent. | ~$38 | ~$43 | | **Tier 3** | Non-Preferred Brand | Drugs with higher costs or those deemed less clinically effective than preferred alternatives. | ~$76 | ~$76 | | **Tier 4** | Non-Formulary | Drugs not on the list. Generally not covered unless medically necessary. | Full Cost | Full Cost |

*Note: Active Duty Service Members (ADSMs) always have $0 copays for formulary drugs at military pharmacies, retail pharmacies, and home delivery.*

### Pharmacy Channels Where you fill your prescription significantly impacts your cost and the formulary rules: 1. **Military Pharmacies:** $0 copay for up to a 90-day supply. They stock mostly Tier 1 and Tier 2 drugs. 2. **TRICARE Pharmacy Home Delivery (Express Scripts):** Best for maintenance medications. 3. **Retail Network Pharmacies:** Best for short-term needs (e.g., antibiotics). 4. **Non-Network Pharmacies:** You will pay the full price upfront and must file a claim for partial reimbursement.

### Restrictions and Requirements Even if a drug is on the formulary, TRICARE may apply: * **Prior Authorization (PA):** Your doctor must prove the drug is medically necessary before TRICARE pays. * **Step Therapy:** You must try one or more "preferred" (cheaper) drugs before TRICARE will cover the requested drug. * **Quantity Limits:** Restrictions on how much medication you can receive per fill or over a period of time.

Who this applies to

* **Active Duty Service Members (ADSMs):** Full coverage with $0 copays, but must use military pharmacies or Express Scripts for secondary needs. * **Active Duty Family Members (ADFMs):** Subject to tier-based copays unless using a military pharmacy. * **Retirees and their Families:** Subject to the highest tier-based copays and annual deductible requirements depending on the plan (Select vs. Prime). * **TRICARE For Life (TFL) Beneficiaries:** Use the TRICARE formulary as their primary pharmacy benefit, even though Medicare is their primary medical insurance.

Common scenarios

**Scenario 1: Generic Maintenance Meds** John is a retiree on TRICARE Select. He takes a generic statin (Tier 1). By using **Express Scripts Home Delivery**, he pays a **$13 copay** for a 90-day supply (2026 rates). If he went to a retail pharmacy every month, he would pay $16 each time, totaling $48 for the same 90-day period.

**Scenario 2: Non-Preferred Brand Approval** Sarah’s doctor prescribes a Tier 3 "Non-Preferred" medication because she had an allergic reaction to the Tier 1 and Tier 2 alternatives. If her doctor submits a **medical necessity waiver**, Sarah may be able to get the Tier 3 drug at the Tier 2 copay rate ($38 instead of $76 at Home Delivery).

**Scenario 3: The "Specialty" Medication** Mark requires a high-cost specialty drug for rheumatoid arthritis. This drug is on the TRICARE formulary but requires **Prior Authorization**. Mark's doctor sends clinical notes to Express Scripts. Once approved, Mark must fill this through the TRICARE Specialty Pharmacy to ensure his $38 copay applies.

Related terms

* **Express Scripts:** The private company that serves as the Pharmacy Benefit Manager (PBM) for all TRICARE plans. * **Maintenance Medication:** Drugs taken daily for chronic conditions (e.g., blood pressure, diabetes) which TRICARE often requires be filled via Home Delivery. * **Medical Necessity:** A formal determination that a specific Tier 3 or non-formulary drug is required because Tier 1 or 2 options are ineffective or unsafe for the patient. * **MTF (Military Treatment Facility):** An on-base hospital or clinic where prescriptions are filled for $0. * **Step Therapy:** A "fail-first" policy requiring patients to try lower-cost drugs before "stepping up" to more expensive ones.

Sources

* **TRICARE.mil Pharmacy Page:** https://www.tricare.mil/pharmacy * **TRICARE Formulary Search Tool:** https://www.express-scripts.com/tform * **Defense Health Agency (DHA) Resources:** https://health.mil/