Your Medications, Our Coverage
Johns Hopkins USFHP offers all of the TRICARE Prime® comprehensive prescription drug benefits, as mandated by the DoD. We are proud to provide our members with convenient access to their medication when they need it most.
We offer two convenient ways for our members to receive their prescriptions:
- Home delivery: available to Maryland and Northern Virginia residents for up to a 90-day supply of approved medications
- 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.
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)
- Non-preferred brand drugs (Tier 3)
Each of these tiers represents a cost share that USFHP members are responsible for paying.
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
- Smoking cessation products at no out of pocket cost (maximum of 2 quit attempts per year)
- 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 smoking cessation products)
- Weight reduction products
Prescription drugs that are picked up at a retail network pharmacy for up to a 30-day supply:
- $11 for generic drugs
- $28 for brand name drugs
- $53 for non-formulary drugs
Home delivery of a prescription drug for up to a 90-day supply (maintenance medications only):
- $7 for generic drugs
- $24 for brand name drugs
- $53 for non-formulary drugs
You can view the cost share for a medication using the TRICARE formulary search tool. You can also search for lower cost alternatives to a medication you are currently taking.
US Family Health Plan members who have Other Health Insurance (OHI) can take advantage of online coordination of benefits (COB).
Advantages of having your COB claims processed online include:
- Zero out-of-pocket expense
- No need to submit paper claims
- Reduced or eliminated up-front costs
US Family Health Plan becomes the first payer when:
- The drug is not covered by your OHI, but is covered by TRICARE
- Coverage under your OHI is exhausted for the benefit year
If you are using a mail order program available through your OHI, online COB is not an option.