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TRICARE Prior (Rx) Authorization Form

TRICARE Prior (Rx) Authorization Form

Updated July 27, 2023

A TRICARE prior authorization form is a document to be completed by a prescribing physician requesting a specific type of medication for their patient which is otherwise not covered by their TRICARE plan. TRICARE is a civilian health care program for military personnel and their dependents, therefore the Department of Defense (D0D) only authorizes drug therapy for patients if it is the most effective, efficient, and fiscally responsible option. If the physician believes that a certain brand of medication will help their patients condition, they may choose to prescribe this brand over the generic product. Alternatively, if the physician doubts the capability of a generic or brand-name product, they may choose to request prior authorization for compounded medications. This form is only used if the patient’s condition has not improved after trying generic or commercially-available brands of medications and are seeking alternative treatment. Once filled-in, the TRICARE prior authorization form should be signed and dated by the prescribing physician and faxed (or mailed) to TRICARE for evaluation.