- Form can be faxed to: 1 (866) 684-4477
- Form can be mailed to: Express Scripts, P.O. Box 52150, Phoenix, AZ, 85072-9954
- TRICARE Brand Over Generic Prior (Rx) Authorization Form
- All TRICARE Forms
TRICARE Prior (Rx) Authorization Form
A TRICARE prior authorization form is completed by a prescribing physician who is requesting a specific type of medication for their patient which is otherwise not covered by their TRICARE plan. The physician must sufficiently justify the request in order to obtain approval from the insurance company.
Updated November 18, 2024
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