Specialty Tier: TRICARE Pharmacy Guide | TRICARE.com

*Note: TRICARE.com is an independent reference site and is not affiliated with the Department of Defense. For official policy, visit TRICARE.mil.*

## Definition The Specialty Tier (also known as Tier 3) is a TRICARE pharmacy category for high-cost or unique medications, such as those used for complex conditions like cancer or rheumatoid arthritis, which carry the highest out-of-pocket copayments.

## What it means in practice For most TRICARE beneficiaries, medications are divided into four categories: Tier 1 (Generic), Tier 2 (Brand Name), Tier 3 (Specialty/Non-Preffered), and Tier 4 (Non-Covered). If your doctor prescribes a medication labeled as "Specialty," it typically means the drug is chemically complex, requires special handling or monitoring, and is significantly more expensive for the Defense Health Agency to procure.

Under the current TRICARE pharmacy benefit managed by Express Scripts, specialty drugs must usually be filled through the TRICARE Home Delivery service or at a military pharmacy if available. Filling these prescriptions at a retail pharmacy often results in the beneficiary paying the full cost of the drug unless a medical necessity waiver is approved.

For the 2026 plan year, copayments for Tier 3 medications vary depending on the delivery method. For a 90-day supply via Home Delivery, Active Duty Family Members and retirees typically pay approximately $91. If a beneficiary chooses to use a non-network retail pharmacy, they may be responsible for the full retail cost until their deductible is met, and then a percentage of the remaining cost. Note that Active Duty Service Members (ADSMs) continue to have $0 copays for all covered medications.

## Related terms * **Formulary:** The official list of brand-name and generic drugs covered by the TRICARE pharmacy benefit. * **Express Scripts:** The private contractor that manages the TRICARE pharmacy program, home delivery, and retail network. * **Quantity Limits:** Restrictions on the amount of a specific medication a beneficiary can receive per prescription or over a certain period. * **Prior Authorization:** A requirement that your doctor get approval from TRICARE before a specific medication (often a specialty drug) will be covered. * **Non-Formulary (Tier 3):** A category of drugs that are not on the preferred list and require the highest cost-share from the beneficiary.

## Sources * TRICARE.mil: [Pharmacy Costs](https://www.tricare.mil/Costs/PharmacyCosts) * Express Scripts: [TRICARE Pharmacy Program](https://militaryrx.express-scripts.com/) * Defense Health Agency: [TRICARE Formulary Search Tool](https://www.express-scripts.com/frontend/open-enrollment/tricare/fst/#/)