TRICARE Non-Formulary Drugs: Costs & Coverage Rules | TRICARE.com

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## Definition A "Non-Formulary" medication is a drug that is not on TRICARE’s list of preferred medications but is still available to beneficiaries at the highest out-of-pocket cost.

## What it means in practice When a drug is classified as "Non-Formulary" (also known as Tier 3), it means the Department of Defense Pharmacy and Therapeutics Committee has determined that the drug is less clinically effective or less cost-effective than other drugs in the same therapeutic class. While TRICARE will still cover these drugs in most cases, they come with a significantly higher copayment than Tier 1 (Generic) or Tier 2 (Brand Name) medications.

For 2026, the cost for a 90-day supply of a non-formulary drug through the TRICARE Pharmacy Home Delivery is typically $76. At a retail network pharmacy, the cost for a 30-day supply is also $76. In contrast, generic drugs (Tier 1) often cost as little as $16. If you are an active duty service member, you can receive non-formulary drugs at $0 copay if they are available at a military pharmacy, though military pharmacies rarely stock non-formulary items unless there is a specific medical necessity.

If your doctor can prove that a non-formulary drug is medically necessary—meaning that all formulary (Tier 1 and Tier 2) alternatives have failed or would be ineffective for you—you may be able to have the drug reclassified for your specific case. If a medical necessity waiver is approved by Express Scripts, you can receive the non-formulary drug at the lower Tier 2 "Brand Name" copay price.

It is important to note that some drugs are "Non-Covered" or "Excluded" entirely. These are different from Non-Formulary drugs. While you can buy a Non-Formulary drug by paying the higher Tier 3 price, TRICARE will not pay for any portion of an Excluded drug (such as those for weight loss or cosmetic purposes).

## Related terms * **Formulary:** The official list of brand-name and generic drugs covered by TRICARE. * **Medical Necessity:** A formal determination that a specific drug or service is required to treat a condition and that no cheaper alternative will suffice. * **Tier 1 (Generic):** The lowest-cost drug category, consisting of drugs no longer protected by patents. * **Tier 2 (Brand Name):** Preferred brand-name drugs that are on the TRICARE formulary but cost more than generics. * **Express Scripts:** The pharmacy benefit manager that handles all TRICARE prescriptions and home delivery services. * **Prior Authorization:** A requirement that your doctor get approval from TRICARE/Express Scripts before a specific medication is covered.

## Sources * TRICARE.mil - Pharmacy Costs: https://www.tricare.mil/Costs/PharmacyCosts * TRICARE.mil - Formulary Search Tool: https://www.express-scripts.com/frontend/open-enrollment/tricare/formulary * Defense Health Agency - P&T Committee: https://health.mil/Military-Health-Topics/Business-Operations/Pharmaceutical-Operations/PT-Committee