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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 respective 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.

MTF Restriction Program

Restriction Requests
MTF Providers, Nurse Case Managers, and/or Pharmacists may enroll identified patients into the PMP by submitting the MTF Restriction Request Form to Express Scripts via secure fax or email. The requestor, or point of contact, designates one of the restriction types below and the authorized provider(s) and/or pharmacy.

  • Type I Lock: Restrict all medications
  • Type II Lock: Restrict controlled medications or selected drug schedule
  • Type III Lock: Restrict specific medication or drug list

MTF Rx Restriction Request Form (PDF file)

Restriction Modifications
To modify a restriction, the point of contact may submit the restriction request form via secure fax or email and should include the updated provider and/or pharmacy information. Restriction override and removal forms may be requested through the Express Scripts Prescription Monitoring Department.

Express Scripts facilitates the restriction as requested. The MTF point of contact manages the restriction and must notify Express Scripts if updates are needed.

System Messaging
Prescriptions that are 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 MTF points of contact.

MTF Prescription Monitoring Report (M290)

  • Restriction activity for the month
  • Current restriction detail
  • Previously identified at risk patients
  • Patients out of compliance
  • Providers prescribing to patients restricted to other MTFs
  • Providers prescribing high volumes of controlled medications

Prescription Monitoring Program Utilizer Report (Q240)

  • Current restriction detail
  • Patients out of compliance
  • Identified at risk patients enrolled to the site
  • Pharmacy claim detail supporting at risk status
  • Previously identified at risk patients

To request access to PMP reporting or to update the PMP point of contact list, email the Express Scripts Prescription Monitoring Department: TRICARE111@express-scripts.com.

*Monthly reporting (M290) is available for MTFs with active restrictions and quarterly reporting (Q240) is available for sites with identified at risk beneficiaries that are empaneled to the MTF.

Managed Care Support Contractor Restriction Program

The TRICARE® MCSC requests enrollment through the Express Scripts Prescription Monitoring Department. Enrollment is targeted for beneficiaries covered under the TRICARE® Managed Care Support Contractors. 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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