Glossary
Non-Network Pharmacy
A civilian pharmacy that is NOT contracted with Express Scripts — highest cost and usually requires you to pay up front and file a claim.
Also known as: out-of-network pharmacy
Quick answer
A non-network pharmacy is any pharmacy not under contract with Express Scripts. TRICARE will still reimburse, but you pay 100% up front, then file a manual paper claim. Reimbursement is at TRICARE-allowable rates and you owe the highest copay tier plus any amount above the TRICARE rate.
Why it matters
Non-network fills are the most expensive way to get a TRICARE prescription. Use only when no network option is available (eg. emergency travel).
Why this matters at age 65
Some independent and specialty pharmacies operate outside the network. Always check before filling.
When you'll encounter it
Travel emergencies, rural areas with no network option, specialty pharmacies that haven't joined the network.
Impact on Medicare
None — Medicare is not involved in pharmacy claims.
Impact on TRICARE For Life
You pay full retail up front. File DD Form 2642 with Express Scripts for partial reimbursement. Expect to be left with significant OOP.
Impact on Medicare Advantage
If you have MA-PD, the non-network pharmacy may bill the MA-PD plan instead — sometimes cheaper than the TRICARE non-network calculation.
Military-specific context
Mail claim form DD 2642 and the original receipt to Express Scripts. Allow 4–6 weeks. Keep copies.
Common misconceptions
- "Non-network just means I pay a bigger copay." — You pay the full retail price up front and must file a paper claim. Reimbursement is partial.
Common mistakes to avoid
- Filling at a non-network pharmacy out of convenience without realizing the cost.
- Losing the receipt before filing the claim.
Real-world scenario: A retiree on a road trip needs an inhaler refill at a small-town independent pharmacy not in the network.
He pays $85 cash, keeps the receipt, files DD 2642 with Express Scripts, and is reimbursed about $40 several weeks later — net cost ~$45 vs. ~$13 at network retail.
What should I do?
- 1Use the pharmacy locator at militaryrx.express-scripts.com to find network options before traveling.
- 2If you must use non-network, save the receipt and file DD 2642 promptly.
- 3Plan refills before long trips to avoid emergency non-network fills.
Continue learning
— suggested by the knowledge graph- Prescription drug coverage under TRICARE For LifeWhy TFL beneficiaries use TRICARE Pharmacy (Express Scripts), not Medicare Part D — and how the four pharmacy options compare.
- What is TRICARE For Life? The complete guide for retired militaryThe Medicare-wraparound benefit you earned through service — what it covers, who qualifies, what it costs, and how it activates.
- How Medicare and TRICARE For Life work togetherThe exact mechanics of who pays first, who pays second, and what you owe — for every common care scenario.
- How Medicare and TRICARE For Life claims are paidThe mechanics of the Medicare-to-TFL crossover system — what providers do, what WPS does, and what to do if a claim gets stuck.
- Brand-Name DrugsFDA-approved drugs sold under a manufacturer's proprietary name — middle copay tier on the TRICARE formulary.
- Generic DrugsChemically identical, FDA-approved equivalents of brand-name drugs — the lowest copay tier under TRICARE Pharmacy.
- Medical NecessityA documented clinical justification that a non-formulary or restricted drug is required — allowing TRICARE to cover it at a lower tier.
- Non-Formulary DrugsDrugs not on the TRICARE preferred list — highest copay tier, often requires Medical Necessity approval.
- Pharmacy CopaymentsThe flat dollar amount a TFL beneficiary pays per prescription — varies by drug tier and access point.
- Pharmacy Prior AuthorizationA pre-approval requirement Express Scripts imposes on certain drugs before TRICARE Pharmacy will pay.
- TRICARE Home DeliveryTRICARE's mail-order pharmacy through Express Scripts — 90-day supplies of maintenance medications at the lowest retail-equivalent copay.
- Do I have to file claims myself?Almost never. Medicare and TFL claims cross over automatically. The exceptions are non-network pharmacy, overseas care, and providers who opt out of Medicare.
- Who pays first, Medicare or TRICARE For Life?Medicare pays first for any service it covers. TFL pays second. The claim usually crosses over automatically — you should never pay out of pocket up front.
- How much does Medicare Part B cost?Most people pay the standard Part B premium (roughly $185/month in 2026). Higher-income retirees pay IRMAA on top. Lower-income retirees may qualify for help paying it.
- Should I enroll in Medicare Part D?No, for almost every TFL beneficiary. TRICARE Pharmacy (Express Scripts) is creditable coverage and cheaper than most Part D plans. Adding Part D usually costs more without adding benefit.
- Is there an enrollment fee for TRICARE For Life?No. TFL has no enrollment fee and no monthly premium. The only premium you pay is for Medicare Part B.
Related glossary terms
Related Official Resources
Continue learning straight from the source. Every link below goes to an official government or DoD resource.
Last reviewed January 2026 against the 2026 Medicare & You and TRICARE For Life handbooks.