Retail Pharmacy Network:
The retail pharmacy network is comprised of 5,170 Rite Aid Pharmacies and Eckerd Pharmacies, nationwide. Retail prescriptions may be filled for up to a 30-day supply, and mail order up to a 90-day supply. However, beneficiaries may fill up to a 90-day supply at any of the network retail pharmacies for the same co-pay as mail order. To locate a Rite Aid pharmacy near you, you may log onto http://www.riteaid.com/stores/locator/
Mail Order:
Beneficiaries may also obtain up to 90 day supply of eligible medications by mail. To use the Mail Order option, send the original copy of your prescription and a check or credit card payment for your co-pay to the Rite Aid pharmacy, at Wyman Park
Rite Aid Pharmacy
3300 Wyman Park Drive
Baltimore, MD 21211
410-338-3300
Covered Medications:
The following are covered pharmacy benefits:
- Federal legend drugs
- Compounded medications of which at least one ingredient is a legend drug
- Insulin
- Insulin syringes and needles
- Glucose test strips
Non-Covered Medications:
Medications excluded from the TRICARE benefit by statute or regulation include:
- Smoking cessation products
- Weight reduction products
- Food supplements
- Homeopathic and herbal preparations
- Multivitamins (except prenatal vitamins for pregnant women)
- Drugs prescribed for cosmetic purposes
- Fluoride preparations
- Over The Counter products (except insulin and diabetic supplies)
USFHP utilizes the TRICARE pharmacy formulary. To view formulary status and co-payment status for any drug, click here: TRICARE Formulary Search Tool.
Co-Payments:
USFHP co-payments are consistent with TRICARE Prime co-payments.
Generic Drugs: $3 – for up to 90 days supply
Preferred Brand Drugs: $9 – for up to 90 days supply
Non-preferred Brand Drugs: $22 – for up to 90 days supply
To view co-pay status of a covered drug, click here: TRICARE Formulary Search Tool.
Quantity Limits:
The Department of Defense Pharmacy and Therapeutics Committee has established quantity limits, or days supply on certain medications. If your medical condition warrants use of quantities greater than listed quantities for each drug, your provider may submit a Prior-authorization request form on your behalf. Medical justification for such a request must be provided by your physician. To view the list of drugs subject to quantity limit, click here: TRICARE Quantity Limits.
Brand Name Medications:
If a brand name medication has a generic equivalent, network pharmacists are required to dispense the generic equivalent instead of the brand name medication. If clinically warranted, your provider may submit a clinical request on your behalf, to obtain a brand name medication instead of the generic equivalent. If the request is approved, you will be responsible for the applicable brand co-payment amount. If you choose to hace a prescription filled for a brand name medication that is not considered necessary, you will be responsible for the entire cost of the prescription.
To download a copy of the Pharmacy Prior-Authorization form, click here.
Generic Medications:
Generic drugs are chemically identical to their branded counterparts. They are made with the same active ingredients, and produce the same effects as their brand name equivalents. The Food and Drug Administration (FDA) requires generic drugs to have the same quality, strength, purity, and stability as brand name drugs. Also, the FDA requires that all drugs, including generic drugs be safe and effective. Although generic drugs are chemically identical to their branded counterparts, and are held to the same FDA standards for safety and performance as brand name drugs, they sell for 30-75 percent less. Not all drugs have a commercially available generic alternative, however, 7,602 of the 10,375 drugs listed in the FDA’s Orange Book have generic equivalents. You can save money on your co-payment by choosing generic drugs when applicable. Additional information on generic drugs is available on the FDA web site at, www.fda.gov/cder/ogd/
Prior-Authorization:
Some medications require prior-authorization before they can be dispensed. To initiate a prior-authorization: your provider must complete and fax the appropriate form to the Johns Hopkins Healthcare Pharmacy department at 410-424-4607. The following list of drugs require prior-authorization
- Euflexxa
- Supartz
- Orthovisc
- Hyalgan
- Synvisc
- Humira
- Kineret
- Enbrel
- Caverject/Edex
- Antihemophilic Factors
- Raptiva
- Amevive
- Forteo
- Exjade
- Procrit/Epogen
- Aranesp
- Intron A
- Infergen
- Roferon
- Pegasys/Peg-intron
- Neulasta
- Neupogen
- Zoladex
- Actimune
- Lupron/Depo-Lupron/Eligard
- Symlin
- Growth Hormones (Genotropin, Humatrope, Norditropin, Nutropin, Saizen, Serostim, Protropin, Tev-tropin, Zorbtive
- Fertility Drugs (Fertinex, Brevelle, Pergonal, Repronex, Humegon)
- Revatio
- Thyrogen
- Pulmozyme
- Sensipar
To download a copy of the Pharmacy Prior-Authorization form, click here.
Medical Necessity for Non-Formulary Drugs:
Prescriptions for non-formulary drugs can be filled at the formulary drug co-pay if medically necessary. To view and print medical necessity form to be completed by your provider, click those that apply:
Aceon, Univasc, Uniretic
Aciphex, Prevacid, Protonix, Zegerid
Ambien CR, Rozerem, Sonata
Amerge, Axert, Frova
Antara, Tricor, Lovaza, Welchol
Anzemet
Avapro, Benicar, Diovan Teveten and HCTZ combos
Avodart
Azopt, Betimol, Isatol, Travatan, Travatan Z
Beconase AQ, Rhinocort Aqua, Veramyst, Nasacort AQ
Bystolic
Caduet
Cialis, Viagra
Clarinex, Clarinex D, Xyzal
Cognex
Crestor
Cymbalta
Daytrana, Focalin XR
Detrol, Sanctura
Emsam Patch
Enbrel
Estrostep Fe
Flomax, Avodart AT
Genotropin, Humatrope, Omnitrope, Saizen
Glucose test strips
Isradipine, Dynacirc CR, Cardene SR, Sular
Ketek
Kineret
Lexapro
Loestrin 24 Fe
Loprox, Spectazole, Oxistat, Ertaczo, Exelderm
Lybrel
Lyrica
Metaproterenol, Maxair
Miacalcin
Nasal Corticosteroids
Ovcon 35
Ovcon 50
Paxil CR
Pristiq
Prozac Weekly
Sarafem
Seasonale, Seasonique
Tarka
Ultram ER
Verelan, Verelan PM, Covera HS, Cardizem LA
Vyvanse
Wellbutrin XL
Zmax
Zyflo, Zyflo CR
Out of Network Claims:
In the event that you fill a prescription at a non-network pharmacy due to an emergent situation, you may seek reimbursement for incurred cost. To obtain reimbursement, complete the Prescription Drug Claim form, and mail to the address indicated on the form. You will be reimbursed for the cost of the prescription less applicable co-payment.
Click here for Prescription Drug Claim form
Drug Information:
To view information on a drug, including how to take the medication, the possible side effects and drug interactions, click here
