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TRICARE Prior Authorization and Medical Necessity Forms

TRICARE has no single pharmacy prior authorization form: each drug that needs prior authorization, or a medical necessity review because it is non-formulary, has its own Express Scripts form. Prescribers find the right one by searching the drug in the TRICARE Formulary Search Tool, then download, complete and send it. Prior authorization and medical necessity are separate reviews, and a drug may need both.

Who completes it

The prescriber completes the drug-specific form, answering that drug's criteria questions and signing it; instructions are printed on each form.

Submitting and payment

How to submit it
The prescriber calls or faxes Express Scripts, or the patient attaches the completed form to the prescription and mails it, or emails the form alone, to the TRICARE pharmacy prior authorization contacts printed on the form.
Who pays
With an approved medical necessity review, a non-formulary drug is available at the formulary cost-share, and at no cost for active duty service members.

Good to know

  • Prior authorization approvals apply at military pharmacies, home delivery and network pharmacies; medical necessity approvals apply only to home delivery and network pharmacies.
  • Prior authorization can be triggered by DoD Pharmacy and Therapeutics Committee criteria, a brand drug with a generic substitute, age limits, or exceeding the normal quantity limit.
  • Active duty members need a medical necessity approval to get non-formulary drugs. Once a non-preferred drug is approved through step therapy, that approval has no expiration date.
  • Quantity limits allow up to a 90-day supply at military pharmacies and home delivery and up to 30 days at network pharmacies, with exceptions when medical necessity is established.

Get the official form

Download the current version from the source each time; forms change without notice.

TRICARE drug-specific Prior Authorization Request and Medical Necessity forms

Official page

Fill it with Vero

If your copy of the form is a fillable PDF, upload it once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.

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How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.

Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.

Frequently asked questions

Where do I find the TRICARE prior authorization form for a specific drug?

Search the drug in the TRICARE Formulary Search Tool run by Express Scripts and download the form listed for it. If the right form cannot be found, contact Express Scripts. Each form carries its own instructions and criteria questions for that drug.

What is the difference between TRICARE prior authorization and medical necessity?

Prior authorization checks that a drug is safe, effective, medically necessary and cost-effective before TRICARE covers it. Medical necessity is a determination that a non-formulary drug is reasonable for treating a specific condition, which lowers the cost-share. They are separate reviews, and some drugs need both.

Does a TRICARE prior authorization work at military pharmacies?

Yes. Prior authorization approvals apply at military pharmacies, home delivery and network pharmacies. Medical necessity approvals for non-formulary drugs apply only to home delivery and network pharmacies, not to military pharmacies.