Comprehensive Pharmacy & Medication Coverage
Johns Hopkins USFHP utilizes the TRICARE® pharmacy formulary. The formulary lists all of the prescription drugs that are covered under the TRICARE benefit. It is a tiered, open formulary, and includes generic drugs (Tier 1), preferred brand drugs (Tier 2), and non-preferred brand drugs (Tier 3). Each of these tiers represents a cost share that USFHP members are responsible for paying.
You can also find information about medications, including how to take them, possible side effects, and drug interactions. Registration is required for first-time users. Log in and see “Health Resources”.
The formulary is updated on a regular basis to include tier changes and utilization (UM) requirements. Review the latest formulary changes.
Some medications require prior authorization from our plan before they can be dispensed by your pharmacist. This helps us ensure that your prescriptions are medically necessary.
For a list of drugs that require prior authorization, refer to the TRICARE Prior Authorization page.
To initiate a prior authorization, your doctor must complete and fax the prior authorization form for the specific medication to the Johns Hopkins Health Plans Pharmacy department at 410-424-4037. In case the medication is not listed, your doctor may use the non-drug specific prior authorization form.
Please note: If another Health Plan or Tricare has previously approved a medication, USFHP will not have access to that information. If you or your provider have a copy of the previous approval letter, please fax it along with the Prior Authorization Form to USFHP.
Step therapy is a process where we look for ways to provide our members the most cost-effective medication that is safe and clinically effective for their condition. The preferred prescribed medication is often a generic version that offers the best overall value in terms of safety, effectiveness, and cost. Non-preferred drugs are only prescribed if the preferred medication is ineffective or poorly tolerated.
Drugs subject to step therapy will be approved for first-time users only after they have tried one of the preferred agents as covered in the TRICARE formulary. When medically necessary, your doctor can request an exception to the step therapy requirement. Your doctor must complete and fax the prior authorization form for the specific medication to the Johns Hopkins Health Plans Pharmacy department at 410-424-4037. In case the medication is not listed, your doctor may use the non-drug specific prior authorization form.
Quantity limits are established for certain drugs to ensure the medication is being used correctly. If your medical condition warrants a larger quantity of your medication than the listed quantity limit, your doctor should submit a prior authorization request.
Co-Pay reduction for non-formulary drugs
If your doctor can establish that you are not able to be treated with generic or preferred formulary brand medications, you can get non-formulary drugs at a network pharmacy, or through home delivery. Your doctor can request a co-pay reduction on your behalf by completing and submitting a non-formulary co-pay reduction request form. If the requested drug also requires prior authorization, your doctor should submit a prior authorization request as well.