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  • Express Scripts Tricare Prior Authorization Form

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Antilipidemic Drugs I - Prior Authorization Request Form MAIL ORDER and RETAIL To be completed and signed by the prescriber. To be used only for prescriptions which are to be filled through the Department of Defense DoD TRICARE Mail Order Pharmacy TMOP OR the TRICARE Retail Pharmacy Program TRRx. O. Box 52150 Phoenix AZ 85072-9954 or email the form only to TpharmPA express-scripts. com Prior authorization criteria and a copy .

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An Express Scripts prior authorization form is meant to be used by medical offices when requesting coverage for a patient's prescription.

Some services need prior authorization. Your provider must request prior authorization from your regional contractor, when needed. Tricare Prime members who are: Active duty service members enrolled in Tricare Prime Remote.

Getting pre-authorization means you're getting the care approved by your regional contractor before you go to an appointment and get the care. If you have a referral, then your provider gets pre-authorization at the same time.

You can check the status of requests and view copies of determination letters online (log in to the Secure Portal), or use the automated self-service tools at 1-844-866-WEST (1-844-866-9378).

You should allow about three business days for HNFS to process your referral. It may take less time if your PCM determines your referral to be “clinically urgent.” You can check your referral status by logging in to your secure account.

How to Get Pre-Authorization Download and print the form for your drug. Give the form to your provider to complete and send back to Express Scripts. Instructions are on the form. You don't need to send multiple forms. Your authorization approval will apply to military pharmacies, network pharmacies, and home delivery.

The TRICARE Pharmacy Program provides the prescription drugs you need, when you need them, in a safe, easy, and affordable way. TRICARE's prescriptions are managed through the pharmacy contractor, Express Scripts.

Your doctor can initiate the prior authorization process by calling Express Scripts toll-free at 800‑417‑8164 or by fax at 800‑357‑9577. If you plan to fill your prescription at a retail pharmacy, consider completing the prior authorization with your doctor before you go to the pharmacy.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232