TRICARE Formulary: Definition and Drug Tiers Explained | TRICARE.com

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## Definition A formulary is a dynamic list of brand-name and generic prescription drugs that are covered by the TRICARE health plan and managed by Express Scripts.

## What it means in practice The TRICARE Formulary determines how much you pay for your medication and where you can fill your prescription. It is managed by the Department of Defense Pharmacy and Therapeutics (P&T) Committee, which meets quarterly to decide which drugs provide the best clinical value. The formulary is divided into four "tiers" that dictate your out-of-pocket costs.

For most beneficiaries in 2026, the cost-sharing structure follows these tiers: * **Tier 1 (Generic):** The lowest out-of-pocket cost. These are widely available at military pharmacies for $0 or via TRICARE Pharmacy Home Delivery. * **Tier 2 (Brand-Name):** Preferred brand-name drugs that are proven effective. These carry a higher copay than generics. * **Tier 3 (Non-Preferred):** These are brand-name drugs that have not been designated as "preferred." You will pay a significantly higher copay for these medications. * **Tier 4 (Non-Formulary):** Drugs that are generally not covered because they provide little clinical advantage over others, or are safely excluded. Generally, you pay the full retail price for these unless a medical necessity can be proven.

In practice, if your doctor prescribes a medication that is "off-formulary," TRICARE may require **Prior Authorization** or **Step Therapy** (trying a cheaper, preferred drug first) before they agree to cover the more expensive version. You can check the status of any drug using the TRICARE Formulary Search Tool provided by Express Scripts. In 2026, using military pharmacies remains the most cost-effective option, as there are $0 copays for formulary drugs filled at an Military Treatment Facility (MTF).

## Related terms * **Express Scripts:** The pharmacy benefit manager that administers the TRICARE prescription program. * **Maintenance Medications:** Drugs taken regularly for chronic conditions, which TRICARE often requires to be filled via Home Delivery. * **Medical Necessity:** A formal justification from a provider that a non-formulary drug is required because preferred drugs are ineffective or cause side effects. * **Prior Authorization:** A requirement that your doctor get approval from TRICARE before certain high-cost or specialized drugs can be covered. * **Step Therapy:** A protocol requiring you to try a lower-cost "Tier 1" drug before TRICARE will authorize a more expensive brand-name drug.

## Sources * TRICARE.mil - Pharmacy Program: https://www.tricare.mil/pharmacy * Express Scripts TRICARE Formulary Search Tool: https://www.express-scripts.com/frontend/open-enrollment/tricare/fst/#/ * Defense Health Agency (DHA) - Pharmacy Operations: https://health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/Access-to-Healthcare/Pharmacy-Operations/Pharmacy-and-Therapeutics-Committee