Formulary Information - Over-the-Counter Medications and Supplies

The following over-the-counter products and supplies are available through the retail pharmacy benefit and/or the mail-order pharmacy.

Product Retail Network
Pharmacy Cost Share
Mail Order
Pharmacy Cost Share
Insulin products $17.00 $13.00 -
Blood glucose test strips Formulary: $17.00
Non-formulary: $44.00
Formulary: $13.00
Non-formulary: $43.00
Formulary Products:
BCF: Precision Xtra
UF: Accu-check Aviva, Accu-check Aviva Plus, Freestyle Lite Ascensia, Contour, TRUE test strips.

All others are non-formulary.
Urine glucose test strips $17.00 $13.00 -
Blood & urine ketone/ acetone test strips $17.00 $13.00 -
Syringes and needles used for injectable medications $17.00 $13.00 -
Lancets $17.00 $13.00 As of March 18, 2009, all popular brands of lancets will be available through TRICARE Mail Order Pharmacy. The mail order pharmacy will no longer automatically dispense Becton-Dickinson Ultra Fine II lancets when blood glucose test strips prescriptions are filled. A valid prescription is now required to receive lancets through the mail order pharmacy.
Inhaler spacers $17.00 $13.00 -
Diaphragms $17.00 Not available -

Over-the-counter medications not on this list are not covered by TRICARE and are not available from retail pharmacies or the mail-order program.  Medical supplies and devices not on this list are not reimbursable through the pharmacy benefit, but in many cases are available through the medical benefit.  Please contact your regional contractor or TRICARE Area Office for more information.
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