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Prescription Monitoring Program (PMP)

The Prescription Monitoring Program (PMP) is in place to support Military Treatment Facilities (MTFs) and the TRICARE® Managed Care Support Contractors (MCSCs) with the identification of beneficiaries who are potentially at risk for misuse of prescription drugs. The PMP provides the opportunity for restriction implementation to prevent or decrease the risk of overutilization.

Identification

Express Scripts identifies at risk candidates for enrollment in the PMP on a quarterly basis based on pre-determined criteria, including utilization patterns of controlled substances and/or other high risk medications. Identified beneficiaries are sent to the TRICARE® MCSC or the MTF in which they are enrolled to determine enrollment. Identification can also occur internally by the TRICARE® MCSC or the MTF.

MCSC Restriction Program

The TRICARE® MCSC requests enrollment through the Express Scripts Prescription Monitoring Department. Enrollment is targeted for TRICARE® beneficiaries covered under the TRICARE® Managed Care Support Contractors. The beneficiary is required to select the following for controlled substance prescriptions:

  • One provider
  • One hospital

Restriction Modifications
Beneficiaries enrolled in the PMP may email TRICARE111@express-scripts.com or call 866.333.1348 with program inquiries or to update their provider selections. For urgent inquires, email is the recommended method of communication.

System Messaging
Prescriptions out of compliance with the restriction will process or reject based on where the prescription is filled:

Retail/TMOP/MTF (MHS Genesis)*
Reject with additional messaging dependent on the reject reason:
M2 PHARMACY RESTRICTION
M2 PHARMACY/PHYSICIAN RESTRICTION
M2 PHYSICIAN RESTRICTION

MTF (CHCS)
Override-able lock-in edit returned to the MTF pharmacy processing the claim:
M2 RECIPIENT LOCKED-IN. HAVE BENEFICIARY CALL 800-332-5455x 340567

*Retail claims cannot be overridden, however an MTF Pharmacist may enter a submission code to override the reject at their discretion.

Informes
Express Scripts generates monthly and quarterly PMP reporting and distributes directly to the TRICARE® MCSC points of contact.

Prescription Monitoring Program Region Report (M280)

  • Restriction activity for the month
  • Current restriction detail
  • Previously identified at risk beneficiaries
  • Beneficiaries out of compliance

Prescription Monitoring Program Utilizer Report (Q240)

  • Current restriction detail
  • Beneficiaries out of compliance
  • Identified at risk beneficiaries assigned to the region
  • Claim detail supporting at risk status
  • Previously identified at risk beneficiaries

MTF Restriction Program

The Military Treatment Facility (MTF) requests enrollment in the PMP through the Express Scripts Prescription Monitoring Department. Enrollment is targeted for TRICARE® beneficiaries receiving direct care at the MTF. For more information, click here.

Prescription Monitoring Program Contact Information
Correo electrónico: TRICARE111@express-scripts.com
Teléfono: 866-333-1348
Fax: 866-579-4662
Correo postal: Express Scripts
Prescription Monitoring Department
1 Express Way
St. Louis, MO 63121
Mail Route HQ1-3E08


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