Pharmacy
The TRICARE Prime® Demo by CareSource Military & Veterans™ Pharmacy program offers comprehensive prescription drug coverage and several options for filling prescriptions. All beneficiaries are eligible for the CareSource Military & Veterans (CSMV) Pharmacy Program, administered by Express Scripts®. To fill prescriptions, beneficiaries need a valid prescription and a valid uniformed services ID card or Common Access Card (CAC).
Beneficiaries using the TRICARE Prime Demo CPD plan have the same options for filling prescriptions: military hospitals or clinic pharmacies, home delivery through Express Scripts Pharmacy, TRICARE Prime Demo retail network pharmacies, non-network retail pharmacies, and E-Prescribe.
Learn more about the TRICARE Prime Demo Pharmacy Program at https://tricare.mil/CoveredServices/Pharmacy.
Prescription Drug Coverage
Information about the TRICARE Formulary and pharmacy drug coverage for beneficiaries can be found at
https://tricare.mil/CoveredServices/Pharmacy/Drugs.
Specialty Pharmacy Program
To improve medication compliance, disease state and side effect management, we work with the TRICARE Pharmacy provider, Express Scripts®. For more information about the TRICARE Pharmacy specialty care drug list, visit https://tricare.mil/CoveredServices/Pharmacy/Drugs/SpecialtyMeds.
Provider Administered Drugs
Provider administered drugs/medications that are administered in a professional setting (such as a physician office, hospital, outpatient department, clinic, dialysis center, or infusion center) will be billed to TRICARE Prime Demo.
Please Note: Prior authorization requirements exist for many provider-administered medications.
TRICARE Prime Demo Pharmacy Clinical Policies will be utilized for provider administered drugs requiring prior authorization. CareSource Military & Veterans will process prior authorization requests in accordance with TRICARE requirements and will utilize Pharmacy Clinical Policies for reviewing provider administered drug prior authorization requests.
In addition, any provider who is not a network provider with TRICARE Prime Demo must obtain prior authorization for all non-emergency services provided to a TRICARE Prime Demo beneficiary.
Requests for provider-administered drugs which require prior authorization may be submitted on our secure provider portal. The provider portal is the preferred method to request prior authorization for medication services under the medical benefit. Providers will be required to submit pertinent medical/drug history, prior treatment history and any other necessary supporting clinical information with the request.
Online
Visit CareSourceMilitary.com > Login > Provider.
Email us at CiteAutoAssistance@CareSource.com for portal login assistance.
Alternate methods include:
Fax: 888-399-0271
Questions about physician administered drug prior authorization requests may be directed to 1-833-230-2170.
Prescription Drug Monitoring Program (PMP)
Learn more about our PMP on our Opioid Tool Kit page.