Pharmacy & Prescription Drug Benefits
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 to the Johns Hopkins HealthCare Pharmacy department at 410-424-4037.
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 by submitting a prior authorization request.
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.
You can get non-formulary drugs at a network pharmacy or through home delivery at the regular formulary copay if medical necessity is established according to criteria established by the Department of Defense Pharmaceutical & Therapy (DoD P&T) Committee. Your doctor can assert medical necessity by submitting a prior authorization request.
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 for the specialty medications covered under pharmacy benefit on the TRICARE Formulary. Have your provider use the Prior Authorization form if needed.
Specialty medications covered under medical benefit are either given to you by your provider or taken while your provider is there with you.
View the HCPCS Codes that require prior authorization for medical necessity and site-of-service.
The DoD’s 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 prior authorization request and approval is granted by USFHP. In those cases, you will pay the brand name copayment. If you insist on having a prescription filled with a brand name drug when a generic equivalent is available, and medical necessity for the brand name drug for you 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 syringes and needles
- Glucose test strips
Prescription medications that are used to treat conditions not currently covered by USFHP by statute or regulation are excluded from the pharmacy benefit.
Excluded medications include:
- Drugs prescribed for cosmetic purposes
- Fluoride preparations
- Food supplements
- Homeopathic and herbal preparations
- Over-the-counter products (except insulin, diabetic supplies, and select OTC products)
- Weight reduction products
- Certain Prescription medications removed from the TRICARE pharmacy benefit program:
|Drug Name||Effective Date of Change|
|Glumetza and generics (Metformin HCl 500 & 1000mg ER 24hr modified release tablet||10/1/2019|
|Vimovo (naproxen/esomeprazole mag) 375/20mg & 500/20mg tablet||10/1/2019|
|Lexette (halobetasol propionate 0.05% foam||10/1/2019|
|Dexilant (Dexlansoprazole) 30 & 60mg capsule||11/27/2019|
|Esomeprazole Strontium 24.65 & 49.3mg capsule||11/27/2019|
Walgreens, Your Pharmacy Network Provider
Johns Hopkins US Family Health Plan’s network includes all Walgreens pharmacies — that’s 8,100 locations and growing. Walgreens offers many digital tools to help you manage your family’s medications and track your healthy behaviors to earn rewards.
Walgreens offers two ways to receive prescriptions: home delivery (for up to a 90-day supply of approved medications) and retail pharmacy pick-up (for a 30-day supply of everyday medications or a 90-day supply of medications for a chronic condition). The Walgreens website and app offer automatic refills and other convenient options to make this even easier.
At some Walgreens locations, you can receive Flu, Pneumonia, Shingles, and other common vaccines.
You can search for local Walgreens locations by visiting caremark.com and entering your ZIP code, city and state, or county and state.
Contact customer service at 410-424-4528 or 1-800-808-7347 if you need assistance finding a network pharmacy.
Filling your prescription
You may obtain your prescriptions at any Walgreens pharmacies nationwide or through home delivery.
Click here to review your Walgreens pharmacy prescription refill options.
Note: You may not obtain prescriptions from a military treatment facility while enrolled in the USFHP. Prescriptions that originated at a military treatment facility may not be transferable to Walgreens pharmacies.
Any prescriptions filled outside the USFHP Pharmacy network in a non-emergent situation may be subject to review to determine if the amount submitted should be reimbursed in full, less applicable co-payment. To obtain reimbursement, complete the Pharmacy Prescription Reimbursement Claim Form, and mail to the address provided on the form.
Here at Johns Hopkins US Family Health Plan, we strive to ensure that every aspect of our members’ health care is the best possible. This is why we partner with Walgreens—a high quality pharmacy that offers great in-person service and a variety of digital tools to make your experience easy and convenient. Try these options:
Use the Walgreens App to:
- Refill your prescriptions. Plus, request refills online or over the phone.
- Track prescription orders.
- Get pill reminders.
- Get free expert advice. Chat with a doctor or pharmacist 24/72 (you can also do this from the Pharmacy Chat option at walgreens.com).
Text Alerts and Faster Pickup
- Text JOINRX to 21525 to receive text notifications when your prescription is ready, needs to be refilled, or is delayed.1
- Pay ahead of time through the link in your “prescription is ready” text. When you get to the store, go through the faster Walgreens ExpressTM pickup line.
Phone or Email Notifications
- If you prefer, Walgreens can call or email you with prescription updates.
- Make fewer trips to the pharmacy! Ask for multiple prescriptions to be filled at the same time.
- Call 833-SAVE-TRIP to get started.
- By signing up, you agree to receive recurring text messages from Walgreens in connection with Pharmacy alerts. Message and data rates may apply. Terms: com/mobileterms. Privacy: walgreens.com/mobileprivacy.
- Availability varies with heavy usage
Home delivery is available to USFHP members for up to a 90-day supply of approved medications through Walgreens Pharmacy. Home delivery is best suited for medications you take on a regular basis.
If you live in Maryland, you may obtain your prescription through home delivery by completing the Maryland mail order form and send it in with your new prescription, plus a check or credit card number for your copayment, to the address listed on the form. To ensure you receive a refill before your current supply runs out, reorder at least two weeks before you need your refill.
2700 Remington Ave.
Baltimore, MD 21211
If you live outside of Maryland, you may obtain your presciption through home delivery from AllianceRx Walgreens Prime Pharmacy located in Arizona. For more information, visit the AllianceRX Walgreens Prime website or view their brochure.
Fill out the home delivery registration and prescription order form and mail to:
AllianceRx Walgreens Prime Pharmacy
P.O. Box 29061
Phoenix, AZ 85038-9601
Phone: 800-345-1985 TTY: 800-573-1833
En español: 800-778-5427TTY: 877-220-6173
Hours of operation:24 hours a day, 7 days a week
Retail pharmacy pick-up
Fill and pick up your prescriptions at any of our network pharmacies nationwide without having to submit a claim. Through our retail pharmacy network, you can fill a 30-day supply of your everyday medications, or a 90-day supply of medications for a chronic condition, for the same copay as home delivery. To fill a prescription, present your Johns Hopkins USFHP Member ID card to the pharmacist with your prescription. Your ID card contains important information to allow the pharmacy to process your claim correctly. You will be responsible for a portion of the cost of the medications, or copay. Copays are subject to change at TRICARE’s discretion. The TRICARE formulary contains three cost levels for USFHP members.
Specialty medications typically require special storage and handling, and may not be readily available at your local pharmacy. Specialty medications may also have side effects that require pharmacist and/or nurse monitoring. Many specialty medications (oral and injectable) are available through the retail pharmacy network. However, some medications may not be available at all retail locations because the medication’s manufacturer limits the medication to specific pharmacies. If your physician submits a request for use of a restricted distribution drug and we approve it, we will forward the request to a contracted specialty pharmacy. The specialty pharmacy will coordinate delivery of the medication to patient’s home or physician office.
Certain common vaccines such as Flu, Pneumonia and Shingles vaccines are available at select Walgreens pharmacies only. Call Customer Service at 410-424-4528 or 1-800-808-7347 to help find a Walgreens pharmacy that administers vaccines. You can also use walgreens.com to search for a location near you. Click “Find a Store” and then search for your local pharmacy. Click on the pharmacy and under “Pharmacy Services” it will list vaccine services, if they are available. Contact the pharmacy to confirm if they are participating in the USFHP pharmacy vaccine network.