| A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z | AA | AB | AC | AD | AE | AF | AG | AH | AI | AJ | AK | AL | AM | AN | AO | AP | AQ | AR | AS | AT | AU | AV | AW | AX | AY | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1 | data source: TriCare.mil accessed 5/27 - 6/1/2025 | ||||||||||||||||||||||||||||||||||||||||||||||||||
2 | |||||||||||||||||||||||||||||||||||||||||||||||||||
3 | Express Scripts TRICARE Pharmacy Reimbursement: ESI Mail Order vs Independent Pharmacies | ||||||||||||||||||||||||||||||||||||||||||||||||||
4 | |||||||||||||||||||||||||||||||||||||||||||||||||||
5 | Express Scripts Self-Owned Mail Order Reimbursement with Breakout | In-Network Independent Pharmacy Reimbursement with Breakout | |||||||||||||||||||||||||||||||||||||||||||||||||
6 | Drug Name | Drug Use | Prescription Quantity | Express Scripts Mail Order | ESI Pays Pharmacy | Patient Copay | California Independent Pharmacies | ESI Pays Pharmacy | Patient Copay | Florida Independent Pharmacies | ESI Pays Pharmacy | Patient Copay | Illinois Independent Pharmacies | ESI Pays Pharmacy | Patient Copay | North Carolina Independent Pharmacies | ESI Pays Pharmacy | Patient Copay | Texas Independent Pharmacies | ESI Pays Pharmacy | Patient Copay | Virginia Independent Pharmacies | ESI Pays Pharmacy | Patient Copay | |||||||||||||||||||||||||||
7 | Lisinopril 20 mg | blood pressure | 90 days | $94.77 | $81.77 | $13.00 | $2.49 | $0.00 | $2.49 | $2.49 | $0.00 | $2.49 | $2.49 | $0.00 | $2.49 | $2.49 | $0.00 | $2.49 | $2.49 | $0.00 | $2.49 | $2.49 | $0.00 | $2.49 | |||||||||||||||||||||||||||
8 | Atorvastatin 20 mg | cholesterol | 90 days | $519.62 | $506.62 | $13.00 | $9.33 | $0.00 | $9.33 | $9.33 | $0.00 | $9.33 | $9.33 | $0.00 | $9.33 | $9.33 | $0.00 | $9.33 | $9.33 | $0.00 | $9.33 | $9.33 | $0.00 | $9.33 | |||||||||||||||||||||||||||
9 | Tamsulosin 0.4 mg | prostate therapy | 90 days | $379.22 | $366.22 | $13.00 | $10.64 | $0.00 | $10.64 | $10.64 | $0.00 | $10.64 | $10.64 | $0.00 | $10.64 | $10.64 | $0.00 | $10.64 | $10.64 | $0.00 | $10.64 | $10.64 | $0.00 | $10.64 | |||||||||||||||||||||||||||
10 | Fingolimod 0.5 mg | multiple sclerosis | 90 days | $33,314.58 | $33,301.58 | $13.00 | $515.64 | $467.64 | $48.00 | $515.64 | $467.64 | $48.00 | $515.64 | $467.64 | $48.00 | $515.64 | $467.64 | $48.00 | $515.64 | $467.64 | $48.00 | $515.64 | $467.64 | $48.00 | |||||||||||||||||||||||||||
11 | Donepezil 10 mg | alzheimer's | 90 days | $700.78 | $687.78 | $13.00 | $5.67 | $0.00 | $5.67 | $5.67 | $0.00 | $5.67 | $5.67 | $0.00 | $5.67 | $5.67 | $0.00 | $5.67 | $5.67 | $0.00 | $5.67 | $5.67 | $0.00 | $5.67 | |||||||||||||||||||||||||||
12 | Metformin 1000 mg | diabetes | 90 days | $129.78 | $116.78 | $13.00 | $1.19 | $0.00 | $1.19 | $1.19 | $0.00 | $1.19 | $1.19 | $0.00 | $1.19 | $1.19 | $0.00 | $1.19 | $1.19 | $0.00 | $1.19 | $1.19 | $0.00 | $1.19 | |||||||||||||||||||||||||||
13 | Abiraterone 250 mg | prostate cancer | 60 days | $5,824.50 | $5,811.50 | $13.00 | $48.34 | $16.34 | $32.00 | $48.34 | $16.34 | $32.00 | $48.34 | $16.34 | $32.00 | $48.34 | $16.34 | $32.00 | $48.34 | $16.34 | $32.00 | $48.34 | $16.34 | $32.00 | |||||||||||||||||||||||||||
14 | Droxidopa 300 mg | blood pressure | 90 days | $9,710.30 | $9,697.30 | $13.00 | $179.07 | $131.07 | $48.00 | $179.07 | $131.07 | $48.00 | $179.07 | $131.07 | $48.00 | $179.07 | $131.07 | $48.00 | $179.07 | $131.07 | $48.00 | $179.07 | $131.07 | $48.00 | |||||||||||||||||||||||||||
15 | Everolimus 5 mg | cancer therapy | 56 days | $654.16 | $641.16 | $13.00 | $343.76 | $311.76 | $32.00 | $343.76 | $311.76 | $32.00 | $343.76 | $311.76 | $32.00 | $343.76 | $311.76 | $32.00 | $343.76 | $311.76 | $32.00 | $343.76 | $311.76 | $32.00 | |||||||||||||||||||||||||||
16 | Imatinib 100 mg | cancer therapy | 60 days | $99.71 | $86.71 | $13.00 | $63.38 | $15.38 | $48.00 | $63.38 | $15.38 | $48.00 | $63.38 | $15.38 | $48.00 | $63.38 | $15.38 | $48.00 | $63.38 | $15.38 | $48.00 | $63.38 | $15.38 | $48.00 | |||||||||||||||||||||||||||
17 | Escitalopram 20 mg | antidepressant | 90 days | $406.31 | $393.31 | $13.00 | $6.57 | $0.00 | $6.57 | $6.57 | $0.00 | $6.57 | $6.57 | $0.00 | $6.57 | $6.57 | $0.00 | $6.57 | $6.57 | $0.00 | $6.57 | $6.57 | $0.00 | $6.57 | |||||||||||||||||||||||||||
18 | Fluoxetine 20 mg | antidepressant | 90 days | $235.32 | $222.32 | $13.00 | $1.45 | $0.00 | $1.45 | $1.45 | $0.00 | $1.45 | $1.45 | $0.00 | $1.45 | $1.45 | $0.00 | $1.45 | $1.45 | $0.00 | $1.45 | $1.45 | $0.00 | $1.45 | |||||||||||||||||||||||||||
19 | Amlodipine 10 mg | blood pressure | 90 days | $213.60 | $200.60 | $13.00 | $0.84 | $0.00 | $0.84 | $0.84 | $0.00 | $0.84 | $0.84 | $0.00 | $0.84 | $0.84 | $0.00 | $0.84 | $0.84 | $0.00 | $0.84 | $0.84 | $0.00 | $0.84 | |||||||||||||||||||||||||||
20 | Carvedilol 25 mg | blood pressure | 90 days | $192.06 | $179.06 | $13.00 | $1.89 | $0.00 | $1.89 | $1.89 | $0.00 | $1.89 | $1.89 | $0.00 | $1.89 | $1.89 | $0.00 | $1.89 | $1.89 | $0.00 | $1.89 | $1.89 | $0.00 | $1.89 | |||||||||||||||||||||||||||
21 | Clopidogrel 75 mg | blood thinner | 90 days | $626.40 | $613.40 | $13.00 | $6.44 | $0.00 | $6.44 | $6.44 | $0.00 | $6.44 | $6.44 | $0.00 | $6.44 | $6.44 | $0.00 | $6.44 | $6.44 | $0.00 | $6.44 | $6.44 | $0.00 | $6.44 | |||||||||||||||||||||||||||
22 | Metoprolol ER 25 mg | blood pressure | 90 days | $94.84 | $81.84 | $13.00 | $9.42 | $0.00 | $9.42 | $9.42 | $0.00 | $9.42 | $9.42 | $0.00 | $9.42 | $9.42 | $0.00 | $9.42 | $9.42 | $0.00 | $9.42 | $9.42 | $0.00 | $9.42 | |||||||||||||||||||||||||||
23 | Ezetimibe 10 mg | cholesterol | 90 days | $1,016.70 | $1,003.70 | $13.00 | $12.23 | $0.00 | $12.23 | $12.23 | $0.00 | $12.23 | $12.23 | $0.00 | $12.23 | $12.23 | $0.00 | $12.23 | $12.23 | $0.00 | $12.23 | $12.23 | $0.00 | $12.23 | |||||||||||||||||||||||||||
24 | Timolol 0.5% | glaucoma/blood pressure | 15 days | $1,042.95 | $1,029.92 | $13.00 | $368.31 | $140.31 | $228.00 | $368.31 | $140.31 | $228.00 | $368.31 | $140.31 | $228.00 | $368.31 | $140.31 | $228.00 | $368.31 | $140.31 | $228.00 | $368.31 | $140.31 | $228.00 | |||||||||||||||||||||||||||
25 | Omeprazole 40 mg | acid reflux | 90 days | $665.58 | $652.58 | $13.00 | $6.19 | $0.00 | $6.19 | $6.19 | $0.00 | $6.19 | $6.19 | $0.00 | $6.19 | $6.19 | $0.00 | $6.19 | $6.19 | $0.00 | $6.19 | $6.19 | $0.00 | $6.19 | |||||||||||||||||||||||||||
26 | Montelukast 10 mg | asthma | 90 days | $509.09 | $496.09 | $13.00 | $3.09 | $0.00 | $3.09 | $3.09 | $0.00 | $3.09 | $3.09 | $0.00 | $3.09 | $3.09 | $0.00 | $3.09 | $3.09 | $0.00 | $3.09 | $3.09 | $0.00 | $3.09 | |||||||||||||||||||||||||||
27 | |||||||||||||||||||||||||||||||||||||||||||||||||||
28 | |||||||||||||||||||||||||||||||||||||||||||||||||||
29 | Express Scripts TRICARE Pharmacy Reimbursement: ESI Mail Order vs Major Chains | ||||||||||||||||||||||||||||||||||||||||||||||||||
30 | |||||||||||||||||||||||||||||||||||||||||||||||||||
31 | Express Scripts Self-Owned Mail Order Reimbursement with Breakout | Major Pharmacy / Grocery Chain Pharmacy Reimbursement with Breakout | |||||||||||||||||||||||||||||||||||||||||||||||||
32 | Drug Name | Drug Use | Prescription Quantity | Express Scripts Mail Order | ESI Pays Pharmacy | Patient Copay | CVS | ESI Pays Pharmacy | Patient Copay | Costco | ESI Pays Pharmacy | Patient Copay | Encore Pharmacy | ESI Pays Pharmacy | Patient Copay | HEB | ESI Pays Pharmacy | Patient Copay | Ingles Pharmacy | ESI Pays Pharmacy | Patient Copay | Kroger | ESI Pays Pharmacy | Patient Copay | Osco Drug | ESI Pays Pharmacy | Patient Copay | Publix | ESI Pays Pharmacy | Patient Copay | Save-On | ESI Pays Pharmacy | Patient Copay | Walgreens | ESI Pays Pharmacy | Patient Copay | |||||||||||||||
33 | Lisinopril 20 mg | blood pressure | 90 days | $94.77 | $81.77 | $13.00 | $2.12 | $0.00 | $2.12 | $2.38 | $0.00 | $2.38 | $2.59 | $0.00 | $2.59 | $1.88 | $0.00 | $1.88 | $2.98 | $0.00 | $2.98 | $2.98 | $0.00 | $2.98 | $3.44 | $0.00 | $3.44 | $1.95 | $0.00 | $1.95 | $3.19 | $0.00 | $3.19 | $1.97 | $0.00 | $1.97 | |||||||||||||||
34 | Atorvastatin 20 mg | cholesterol | 90 days | $519.62 | $506.62 | $13.00 | $1.67 | $0.00 | $1.67 | $1.99 | $0.00 | $1.99 | $4.42 | $0.00 | $4.42 | $2.62 | $0.00 | $2.62 | $4.42 | $0.00 | $4.42 | $2.36 | $0.00 | $2.36 | $2.74 | $0.00 | $2.74 | $2.19 | $0.00 | $2.19 | $3.62 | $0.00 | $3.62 | $1.56 | $0.00 | $1.56 | |||||||||||||||
35 | Tamsulosin 0.4 mg | prostate therapy | 90 days | $379.22 | $366.22 | $13.00 | $3.73 | $0.00 | $3.73 | $3.03 | $0.00 | $3.03 | $8.83 | $0.00 | $8.83 | $4.64 | $0.00 | $4.64 | $8.83 | $0.00 | $8.83 | $5.25 | $0.00 | $5.25 | $5.96 | $0.00 | $5.96 | $3.23 | $0.00 | $3.23 | $5.46 | $0.00 | $5.46 | $3.46 | $0.00 | $3.46 | |||||||||||||||
36 | Fingolimod 0.5 mg | multiple sclerosis | 90 days | $33,314.58 | $33,301.58 | $13.00 | $9,994.37 | $9,946.37 | $48.00 | $9,994.37 | $9,946.37 | $48.00 | $9,994.37 | $9,946.37 | $48.00 | $9,946.37 | $9,898.37 | $48.00 | $9,994.37 | $9,946.37 | $48.00 | $13,454.43 | $13,406.43 | $48.00 | $9,994.37 | $9,946.37 | $48.00 | $9,994.57 | $9,946.57 | $48.00 | $9,994.47 | $9,946.47 | $48.00 | $9,994.37 | $9,946.37 | $48.00 | |||||||||||||||
37 | Donepezil 10 mg | alzheimer's | 90 days | $700.78 | $687.78 | $13.00 | $3.64 | $0.00 | $3.64 | $10.83 | $0.00 | $10.83 | $8.10 | $0.00 | $8.10 | $7.20 | $0.00 | $7.20 | $8.10 | $0.00 | $8.10 | $5.12 | $0.00 | $5.12 | $5.83 | $0.00 | $5.83 | $11.03 | $0.00 | $11.03 | $18.92 | $0.00 | $18.92 | $3.38 | $0.00 | $3.38 | |||||||||||||||
38 | Metformin 1000 mg | diabetes | 90 days | $129.78 | $116.78 | $13.00 | $2.32 | $0.00 | $2.32 | $1.84 | $0.00 | $1.84 | $2.86 | $0.00 | $2.86 | $2.00 | $0.00 | $2.00 | $2.86 | $0.00 | $2.86 | $3.28 | $0.00 | $3.28 | $3.75 | $0.00 | $3.75 | $2.04 | $0.00 | $2.04 | $3.36 | $0.00 | $3.36 | $2.16 | $0.00 | $2.16 | |||||||||||||||
39 | Abiraterone 250 mg | prostate cancer | 60 days | $5,824.50 | $5,811.50 | $13.00 | $2,038.58 | $2,006.58 | $32.00 | $2,038.68 | $2,006.68 | $32.00 | $2,041.31 | $2,009.31 | $32.00 | $2,006.68 | $1,974.68 | $32.00 | $2,041.31 | $2,009.31 | $32.00 | $2,038.58 | $2,006.58 | $32.00 | $2,038.68 | $2,006.68 | $32.00 | $2,041.51 | $2,009.51 | $32.00 | $2,006.68 | $1,974.68 | $32.00 | $2,038.58 | $2,006.58 | $32.00 | |||||||||||||||
40 | Droxidopa 300 mg | blood pressure | 90 days | $9,710.30 | $9,697.30 | $13.00 | $2,524.68 | $2,476.68 | $48.00 | $2,524.68 | $2,476.68 | $48.00 | $2,524.68 | $2,476.68 | $48.00 | $2,476.68 | $2,428.68 | $48.00 | $2,524.68 | $2,476.68 | $48.00 | $2,524.88 | $2,476.88 | $48.00 | $2,524.78 | $2,476.78 | $48.00 | $2,524.88 | $2,476.88 | $48.00 | $2,476.68 | $2,428.68 | $48.00 | $2,524.68 | $2,476.68 | $48.00 | |||||||||||||||
41 | Everolimus 5 mg | cancer therapy | 56 days | $654.16 | $641.16 | $13.00 | $12,891.35 | $12,843.35 | $32.00 | $17,930.56 | $17,898.56 | $32.00 | $12,891.35 | $12,859.35 | $32.00 | $12,859.35 | $12,827.35 | $32.00 | $12,891.35 | $12,859.35 | $32.00 | $12,891.35 | $12,859.35 | $32.00 | $12,891.45 | $12,859.45 | $32.00 | $12,891.55 | $12,859.55 | $32.00 | $12,859.35 | $12,827.35 | $32.00 | $12,891.35 | $12,859.35 | $32.00 | |||||||||||||||
42 | Imatinib 100 mg | cancer therapy | 60 days | $99.71 | $86.71 | $13.00 | $1,820.33 | $1,772.33 | $48.00 | $1,820.30 | $1,772.30 | $48.00 | $1,820.30 | $1,772.30 | $48.00 | $1,772.33 | $1,724.33 | $48.00 | $1,820.30 | $1,772.30 | $48.00 | $1,820.33 | $1,772.33 | $48.00 | $1,820.43 | $1,772.43 | $48.00 | $1,820.50 | $1,772.50 | $48.00 | $1,772.33 | $1,724.33 | $48.00 | $1,820.33 | $1,772.33 | $48.00 | |||||||||||||||
43 | Escitalopram 20 mg | antidepressant | 90 days | $406.31 | $393.31 | $13.00 | $4.13 | $0.00 | $4.13 | $3.38 | $0.00 | $3.38 | $7.66 | $0.00 | $7.66 | $4.96 | $0.00 | $4.96 | $7.66 | $0.00 | $7.66 | $5.82 | $0.00 | $5.82 | $6.61 | $0.00 | $6.61 | $3.58 | $0.00 | $3.58 | $4.96 | $0.00 | $4.96 | $3.84 | $0.00 | $3.84 | |||||||||||||||
44 | Fluoxetine 20 mg | antidepressant | 90 days | $235.32 | $222.32 | $13.00 | $2.78 | $0.00 | $2.78 | $7.66 | $0.00 | $7.66 | $3.16 | $0.00 | $3.16 | $2.31 | $0.00 | $2.31 | $3.16 | $0.00 | $3.16 | $3.92 | $0.00 | $3.92 | $4.48 | $0.00 | $4.48 | $2.41 | $0.00 | $2.41 | $2.31 | $0.00 | $2.31 | $2.58 | $0.00 | $2.58 | |||||||||||||||
45 | Amlodipine 10 mg | blood pressure | 90 days | $213.60 | $200.60 | $13.00 | $1.43 | $0.00 | $1.43 | $1.27 | $0.00 | $1.27 | $1.65 | $0.00 | $1.65 | $1.24 | $0.00 | $1.24 | $1.65 | $0.00 | $1.65 | $2.03 | $0.00 | $2.03 | $2.36 | $0.00 | $2.36 | $1.65 | $0.00 | $1.65 | $1.24 | $0.00 | $1.24 | $1.33 | $0.00 | $1.33 | |||||||||||||||
46 | Carvedilol 25 mg | blood pressure | 90 days | $192.06 | $179.06 | $13.00 | $2.93 | $0.00 | $2.93 | $2.49 | $0.00 | $2.49 | $2.82 | $0.00 | $2.82 | $2.24 | $0.00 | $2.24 | $2.82 | $0.00 | $2.82 | $4.11 | $0.00 | $4.11 | $4.70 | $0.00 | $4.70 | $2.82 | $0.00 | $2.82 | $2.24 | $0.00 | $2.24 | $2.71 | $0.00 | $2.71 | |||||||||||||||
47 | Clopidogrel 75 mg | blood thinner | 90 days | $626.40 | $613.40 | $13.00 | $10.90 | $0.00 | $10.90 | $5.74 | $0.00 | $5.74 | $5.74 | $0.00 | $5.74 | $5.74 | $0.00 | $5.74 | $5.74 | $0.00 | $5.74 | $15.35 | $0.00 | $15.35 | $14.77 | $0.00 | $14.77 | $5.74 | $0.00 | $5.74 | $5.74 | $0.00 | $5.74 | $10.13 | $0.00 | $10.13 | |||||||||||||||
48 | Metoprolol ER 25 mg | blood pressure | 90 days | $94.84 | $81.84 | $13.00 | $2.65 | $0.00 | $2.65 | $5.72 | $0.00 | $5.72 | $16.90 | $0.00 | $16.90 | $9.15 | $0.00 | $9.15 | $16.90 | $0.00 | $16.90 | $3.73 | $0.00 | $3.73 | $4.27 | $0.00 | $4.27 | $16.90 | $0.00 | $16.90 | $9.15 | $0.00 | $9.15 | $2.46 | $0.00 | $2.46 | |||||||||||||||
49 | Ezetimibe 10 mg | cholesterol | 90 days | $1,016.70 | $1,003.70 | $13.00 | $3.38 | $0.00 | $3.38 | $4.77 | $0.00 | $4.77 | $16.19 | $0.00 | $16.19 | $7.99 | $0.00 | $7.99 | $16.19 | $0.00 | $16.19 | $4.76 | $0.00 | $4.76 | $5.43 | $0.00 | $5.43 | $16.19 | $0.00 | $16.19 | $7.99 | $0.00 | $7.99 | $3.14 | $0.00 | $3.14 | |||||||||||||||
50 | Timolol 0.5% | blood pressure | 15 days | $1,042.95 | $1,029.92 | $13.00 | $638.31 | $410.31 | $228.00 | $638.31 | $410.31 | $228.00 | $801.77 | $573.77 | $228.00 | $334.34 | $106.34 | $228.00 | $857.10 | $629.10 | $228.00 | $638.31 | $410.31 | $228.00 | $638.41 | $410.41 | $228.00 | $801.77 | $573.77 | $228.00 | $638.31 | $410.31 | $228.00 | $638.31 | $410.31 | $228.00 | |||||||||||||||
51 | Omeprazole 40 mg | acid reflux | 90 days | $665.58 | $652.58 | $13.00 | $3.85 | $0.00 | $3.85 | $3.11 | $0.00 | $3.11 | $3.97 | $0.00 | $3.97 | $2.93 | $0.00 | $2.93 | $3.97 | $0.00 | $3.97 | $5.54 | $0.00 | $5.54 | $6.28 | $0.00 | $6.28 | $3.97 | $0.00 | $3.97 | $2.93 | $0.00 | $2.93 | $3.65 | $0.00 | $3.65 | |||||||||||||||
52 | Montelukast 10 mg | asthma | 90 days | $509.09 | $496.09 | $13.00 | $2.80 | $0.00 | $2.80 | $2.85 | $0.00 | $2.85 | $9.43 | $0.00 | $9.43 | $5.67 | $0.00 | $5.67 | $9.43 | $0.00 | $9.43 | $4.01 | $0.00 | $4.01 | $4.59 | $0.00 | $4.59 | $9.43 | $0.00 | $9.43 | $5.67 | $0.00 | $5.67 | $2.65 | $0.00 | $2.65 | |||||||||||||||
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