Understanding Tricare Express Scripts Prior Authorization Process

Tricare Express Scripts (ESI) has a prior authorization process that requires approval before certain medications can be filled. This process is designed to ensure that medications are medically necessary and safe for use.

The prior authorization process for Tricare ESI typically takes 2-3 business days to process. However, in some cases, it may take up to 5 business days.

To initiate the prior authorization process, you'll need to contact your doctor or healthcare provider. They'll need to submit a request to Tricare ESI, providing medical justification for the medication.

Your doctor will need to provide specific information, such as your medical history, diagnosis, and treatment plan, to support the request.

Express Scripts is Tricare's Pharmacy Benefit Manager (PBM). They handle all prescription drug claims for Tricare beneficiaries.

Express Scripts is responsible for processing and paying claims for prescription medications. This includes managing the prior authorization process for certain medications.

As Tricare's PBM, Express Scripts has a list of medications that require prior authorization. This list can be found on the Express Scripts website.

Prior authorization is a process that requires a healthcare provider to get approval from TRICARE before prescribing certain medications. This process can take up to 3 business days.

You'll need to submit a prior authorization request through Express Scripts, which can be done online or by calling the pharmacy hotline. The request must be submitted before the medication is filled.

Some medications require prior authorization, including brand-name medications and certain generic medications. You can check the Express Scripts website to see if a specific medication requires prior authorization.

If your healthcare provider has already submitted a prior authorization request, you can check the status online or by contacting Express Scripts.