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Your medical necessity approval will apply at network pharmacies and home delivery. Web tricare pharmacy program medical necessity form for ozempic. If your doctor can establish medical necessity for these drugs, you can get the drug at the formulary (brand) copayment. The medical necessity criteria outlined on this form also apply at military treatment facilities (mtfs). Search for your drug.
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Millions trust express scripts for safety, care and convenience. Web tricare pharmacy program medical necessity form for ozempic. Web please call us at 800.753.2851 to submit a verbal prior authorization request if you are unable to use electronic prior authorization. Instructions are on the form ;
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