Covered Medications

The Department of Defense’s (DoD) policy on generic drugs requires the pharmacy to substitute generic medications for brand-name medications when a generic equivalent is available. Brand-name drugs with a generic equivalent may be given only if your physician submits a brand name prior authorization request and approval is granted by Johns Hopkins US Family Health Plan (USFP). In those cases, you will pay the brand name copayment. If the requested drug also requires prior authorization, your doctor should submit a prior authorization request as well. If you insist on having a prescription filled with a brand name drug when a generic equivalent is available, and medical necessity for your use of the brand name drug has not been established, you will be responsible for the entire cost of the prescription.

Although generic drugs are chemically identical to their branded counterparts and are held to the same FDA standards for safety and performance as brand-name drugs, they sell for 30-75 percent less. You can save money on your co-payment by choosing generic drugs when applicable. Additional information on generic drugs is available on the FDA website.

Other covered medications

Our pharmacy program provides outpatient coverage to members for medications that are approved for marketing by the U.S. Food and Drug Administration (FDA) and that generally require prescriptions. Other covered medications include:

  • Compounded medications of which at least one ingredient is a legend drug
  • Insulin
  • Insulin syringes and needles
  • Glucose test strips *
  • Lancets

You can find coverage and cost share details for specific drugs in the TRICARE formulary search tool.

* Freestyle Lite & Precision Xtra strips are TRICARE preferred test strips, all other test strips will require prior authorization.

All regular Glucose Monitors and Continuous Glucose Monitors, such as Free Style Libre and Dexcom, are covered by your USFHP medical benefit. Use the Durable Medical Equipment (DME) directory to find a supplier.

Specialty Medications

Specialty medications are used to treat complex, long-term conditions. These are medications that may need special storage or have side effects that your health care provider needs to monitor. Some of these medications are covered by your pharmacy benefits and some are covered by your medical benefits.

Specialty medications covered by your pharmacy benefit are available at a local pharmacy. You take these medications on your own. For some of them, your provider may have to ask Johns Hopkins USFHP to approve them. Search the TRICARE Formulary for the specialty medications covered under the pharmacy benefit.

Specialty medications covered under your medical benefit are either given to you by your provider or taken while your provider is there with you. Some of these medical drugs may require prior authorization and your provider may have to ask Johns Hopkins USFHP to approve them.

Your doctor may find a list of medical drugs that have this prior authorization requirement and more information about how to submit a prior authorization request by visiting jhhc.com.

Excluded medications include:

  • Drugs prescribed for cosmetic purposes
  • Fluoride preparations
  • Food supplements
  • Homeopathic and herbal preparations
  • Multivitamins
  • Over-the-counter products (except insulin, diabetic supplies, and select OTC products)
  • Weight reduction products
Drug Class Products not covered/removed from TRICARE Formulary Formulary Alternatives Effective Date of Change
GI-1 Agents Budesonide ER 9 mg capsules (Ortikos)
  • Budesonide ER tablets (Entocort EC, generics)
  • Other corticosteroids
06/02/2021
Corticosteroids Dexamethasone 20 mg tables (Hemady)
  • Dexamethasone generics 0.5, 0.75, 1, 1.5, 2, 4, 6 mg tabs
06/02/2021
Pulmonary I Agents Inhaled Corticosteroids (ICS) Fluticasone propionate dry powder inhaler oral (ArmonAir Digihaler)
  • Fluticasone (Flovent Diskus)
  • Fluticasone (Flovent HFA)
  • Fluticasone furoate (Arnuity Ellipta) [non formulary]
  • Beclomethasone (QVAR) [non formulary]
  • Budesonide (Pulmicort Flexhaler) [non formulary]
  • Ciclesonide (Alvesco) [non formulary]
  • Flunisolide (Aerospan) [non formulary]
  • Mometasone (Asmanex Twisthaler [non formulary]
06/02/2021
Pulmonary I Agents ICS/Long-Acting Beta Agonists (LABA) Fluticasone propionate / salmeterol dry powder inhaler oral (AirDuo Digihaler)
  • Fluticasone/salmeterol (Advair Diskus)
  • Fluticasone/salmeterol (Advair HFA)
  • Fluticasone/vilanterol (Breo Ellipta) [non formulary]
  • Mometasone/formoterol (Dulera) [non formulary]
  • Budesonide/formoterol (Symbicort) [non formulary]
  • Fluticasone/salmeterol (AirDuo Respiclick) [non formulary]
06/02/2021
Calcium Channel Blockers Levamlodipine (Conjupri)
  • Amlodipine
  • Felodipine
  • Nifedipine
  • Diltiazem
  • Verapamil
06/02/2021
GI-2 Agents Metoclopramide nasal spray (Gimoti)
  • Metoclopramide oral tablet (Reglan generics)
  • Metoclopramide oral solution (Reglan, generics)
  • Metoclopramide orally disintegrating tablet (Reglan ODT)
06/02/2021
Topical Psoriasis Agents Calcipotriene 0.005% Betamethasone 0.064% Suspension (Taclonex, Generic) Scalp Psoriasis:

  • Calcipotriene 0.005% solution
  • Clobetasol 0.05% solution, shampoo
  • Fluocinonide 0.05% solution
  • Calcipotriene 0.005% Betamethasone 0.064% foam (Enstilar) [Nonformulary]

Psoriasis involving areas other than the scalp:

  • Calcipotriene 0.005% ointment, cream, solution
  • Clobetasol 0.05% ointment, cream  fluocinonide 0.05% cream, ointment
  • NSAIDs: celecoxib, diclofenac, ibuprofen, meloxicam, naproxen, (also includes other NSAIDs)
2/24/2021
High-Potency Topical Corticosteroids Halcinonide 0.1% topical solution (Halog)
  • Betamethasone propylene glycol 0.05% cream
  • Clobetasol propionate 0.05% cream and ointment
  • Clobetasol propionate/emollient 0.05% cream
  • Desoximetasone 0.25% cream and ointment
  • Fluocinonide 0.05% cream and ointment
  • Fluocinonide/emollient base 0.05% cream
  • Halobetasol propionate 0.05% ointment
2/24/2021
Acne Agents:Topical Acne and Rosacea Tazarotene 0.045% lotion (Arazlo)
  • Adapalene 0.1% lotion, gel, cream
  • Adapalene 0.3% gel
  • Clindamycin phosphate 1% gel, cream, lotion, and solution
  • Clindamycin/ benzoyl peroxide 1.2% -5% gel
  • Tazarotene 0.1% cream
  • Tretinoin 0.025%, 0.05%, and 0.1% cream
  • Tretinoin 0.01% and 0.025% gel
2/24/2021
Pain Agents Class;
NSAIDs Subclass
Consensi (Amlodipine-celecoxib)
  • Dihydropyridine calcium channel blockers: amlodipine, felodipine, nifedipine, isradipine PLUS
  • NSAIDs: celecoxib, diclofenac, ibuprofen, meloxicam, naproxen, (also includes other NSAIDs)
8/26/2020
Pain Agents Class;
NSAIDs Subclass
  • Zipsor liquid-filled capsules (diclofenac potassium)
  • Zorvolex (diclofenac submicronized)
  • Fenoprofen capsules
  • Tivorbex (indomethacin submicronized)
  • Vivlodex (meloxicam submicronized)
NSAIDs: celecoxib, diclofenac, indomethacin, meloxicam, naproxen, (also includes other NSAIDs) 8/26/2020
Pain Agents Class;
NSAIDs Subclass
Duexis tablets (ibuprofen-famotidine)
  • H2 blockers: famotidine, ranitidine, cimetidine, nizatidine PLUS
  • NSAIDs: celecoxib, diclofenac, ibuprofen, meloxicam, naproxen, (also includes other NSAIDs)
8/26/2020
Pain Agents Class;
Pain Topical Subclass
  • Pennsaid 2% (diclofenac 2% solution)
  • Flector, generics (diclofenac 1.3% patch)
  • Oral NSAIDs: celecoxib, diclofenac, indomethacin, meloxicam, naproxen, (also includes other NSAIDs)
  • Diclofenac 1.5% solution
  • Diclofenac 1% gel
8/26/2020
Pain Agents Class;
Pain Topical Subclass
ZTlido (lidocaine 1.8% patch) Lidocaine 5% patch 8/26/2020
Pulmonary: Short Acting Beta-2 Agonists (SABA) ProAir Digihaler (albuterol dry powder inhaler)
  • Albuterol MDI (ProAir HFA)
  • Albuterol DPI (ProAir Respiclick)
  • Albuterol MDI (Proventil HFA) [Nonformulary]
  • Albuterol MDI (Ventolin HFA) [Nonformulary]
  • Levalbuterol MDI (Xopenex HFA) [Nonformulary]
8/26/2020
Acne Agents: Topical Acne and Rosacea Enzoclear (benzoyl peroxide 9.8% foam)
  • Clindamycin/benzoyl peroxide 1.2% -5% gel (Duac, generics)
  • Clindamycin/benzoyl peroxide 1% -5% gel (Benzaclin, generics)
  • Clindamycin/benzoyl peroxide 1% -5% gel kit (Duac CS Kit)
8/26/2020
Anti-Infectives: Miscellaneous Talicia (omeprazole magnesium-amoxicillin-rifabutin)
  • Omeprazole PLUS amoxicillin PLUS rifabutin (given separately)
  • Omeprazole PLUS clarithromycin PLUS amoxicillin
  • Bismuth subsalicylate OTC PLUS metronidazole PLUS tetracycline PLUS PPI
8/26/2020
Rapid Acting Insulins Insulin plus niacinamide (Fiasp)
  • Insulin aspart (Novolog)
  • Insulin lispro (Humalog or authorized generic lispro)
  • Insulin lispro (Admelog) [nonformulary]
  • Insulin glulisine (Apidra) [nonformulary]
07/01/2020
Pulmonary-2 Agents: COPD Formoterol/aclidinium (Duaklir Pressair)
  • Umeclidinium/vilanterol (Anoro Ellipta)
  • Tiotropium/olodaterol (Stiolto Respimat)
  • Glycopyrrolate/formoterol (Bevespi Aerosphere) [nonformulary]
06/10/2020
Migraine Agents: Triptans Sumatriptan nasal spray (Tosymra)
  • Sumatriptan nasal spray (Imitrex, generics)
  • Sumatriptan nasal powder (Onzetra Xsail)
  • Zolmitriptan nasal spray (Zomig)
06/10/2020
GI2 Agents: CIC and IBS-C Tegaserod (Zelnorm)
  • Linaclotide (Linzess)
  • Plecanatide (Trulance)
  • Lubiprostone (Amitiza)
  • Pruclaopride (Motegrity) [nonformulary]
06/10/2020
PDE-5 inhibitor
  • Avanafil tablet (Stendra)
  • Brand Viagra tablet
  • Brand Cialis tablet
  • Vardenafil tablet (Levitra and generics)
  • Vardenafil oral disintegrating tablet (ODT) (Staxyn and generics)
  • Sildenafil tablet (generic Viagra only)
  • Tadalafil tablet (generic Cialis only)
06/03/2020
ADHD Methylphenidate ER sprinkle capsules (Adhansia XR)
  • Methylphenidate ER (Aptensio XR sprinkle capsule) for patients with swallowing difficulties
  • Methylphenidate ER oral suspension (Quillivant XR suspension) for patients with swallowing difficulties
  • Methylphenidate ER osmotic controlled release oral delivery system (OROS) (Concerta, generics)
  • Methylphenidate long-acting (Ritalin LA, generics)
  • Methylphenidate controlled delivery (CD) (Metadate CD, generics)
  • Dexmethylphenidate ER (Focalin XR, generics)
  • Mixed amphetamine salts ER (Adderall XR, generics)
03/04/2020
High-Potency Topical Corticosteroids
  • Clobetasol propionate 0.025% cream (Impoyz>
  • Diflorasone diacetate/emollient 0.05% cream (Apexicon-E)
  • Halcinonide 0.1% cream (Halog)
  • Betamethasone/propylene glycol 0.05% cream
  • Clobetasol propionate 0.05% cream
  • Clobetasol propionate/emollient 0.05% cream
  • Desoximetasone 0.25% cream
  • Fluocinonide 0.05% cream
  • Fluocinonide/emollient base 0.05% cream
03/04/2020
High-Potency Topical Corticosteroids Halcinonide 0.1% ointment (Halog)
  • Betamethasone dipropionate 0.05% ointment
  • Betamethasone/propylene glycol 0.05% ointment
  • Clobetasol propionate 0.05% ointment
  • Desoximetasone 0.25% ointment
  • Fluocinonide 0.05% ointment
  • Halobetasol propionate 0.05% ointment
03/04/2020
High-Potency Topical Corticosteroids
  • Clobetasol propionate 0.05% shampoo/ cleanser (kit) (Clodan kit)
  • Halobetasol propionate 0.05% lotion (Ultravate)
  • Halobetasol propionate 0.05% foam (authorized generic for Lexette) (see Feb 2019 for brand Lexette recommendation)
  • Betamethasone propylene glycol 0.05% lotion
  • Betamethasone dipropionate 0.05% gel
  • Clobetasol propionate/emollient 0.05 % emulsion foam
  • Clobetasol propionate 0.05% solution, lotion, gel, foam, spray, and shampoo
  • Fluocinonide 0.05% solution and gel
03/04/2020
PPIs
  • Dexlansoprazole (Dexilant)
  • Esomeprazole strontium
  • Esomeprazole
  • Omeprazole
  • Pantoprazole
  • Rabeprazole
11/28/2019
High-Potency Topical Corticosteroids Halobetasol propionate 0.05% foam (Lexette brand)
  • Betamethasone/propylene glycol 0.05% lotion
  • Betamethasone dipropionate 0.05% gel
  • Clobetasol propionate/emollient 0.05% emulsion foam
  • Clobetasol propionate 0.05% solution, lotion, gel, foam, spray, and shampoo
10/01/2019
Diabetes Non- Insulin Drugs – Biguanides Subclass Metformin ER gastric retention 24 hours (Glumetza)
  • Metformin IR (Glucophage generic)
  • Metformin ER (Glucophage XR generic)
10/01/2019
Pain Agents – Combinations Naproxen / Esomeprazole (Vimovo)
  • PPIs: omeprazole, pantoprazole, esomeprazole, rabeprazole PLUS
  • NSAIDs: celecoxib, diclofenac, indomethacin, meloxicam, naproxen, (also includes other NSAIDs)
10/01/2019