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Frequently Asked Questions

What is Express Scripts prior authorization?

The Express Scripts Prior Prescription (Rx) Authorization Form is a document that is used by a patient’s prescriber in order to request that a certain non-preferred or non-formulary medication be covered under their insurance policy.

What is the TRICARE formulary?

The TRICARE Uniform Formulary (UF) is a list of brand name and generic drugs and supplies that TRICARE covers. The formulary is: Developed by the Department of Defense (DoD) Pharmacy and Therapeutics (P&T) Committee.

Does Tricare for life require Auth?

Tricare for Life users are only required to get prior authorization in case they have any mental health related problems and they have to be admitted to a hospital.

What is the appeal process for Tricare?

a TRICARE contractor have the right to appeal those decisions. The appeals process varies depending on whether the denial of benefits involves a medical necessity determination, factual determination, provider authorization, provider sanction, and/or a dual-eligible determination.

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