As a proud military spouse, I’ve seen the struggles of managing diabetes. Navigating healthcare can be tough, but TRICARE is here to help. This guide will show you how TRICARE covers diabetic supplies and equipment. You’ll learn how to manage your health with confidence.
Key Takeaways
- TRICARE covers many diabetic supplies, like insulin, blood glucose strips, and more1
- Some supplies might be covered by pharmacy or medical benefits, depending on the item1
- TRICARE also covers eye exams for diabetes, which is key for early detection1
- The Omnipod 5 insulin device is now covered by TRICARE, but you need pre-authorization1
- TRICARE also covers therapeutic footwear and diabetes training, offering full support for managing diabetes
Whether you’re new to diabetes or have been managing it for years, TRICARE is here for you. They ensure you get the supplies and services you need to thrive. By knowing what TRICARE offers, you can take the first step towards better diabetes management and improve your health. Let’s explore the details that will help you make the most of your TRICARE diabetic coverage.
Understanding TRICARE Diabetic Coverage Basics
If you have diabetes and are part of TRICARE, knowing what’s covered is key. TRICARE helps those with diabetes a lot. It’s for active duty, retirees, and their families.
Who Qualifies for TRICARE Diabetes Coverage?
To get TRICARE’s help for diabetes, you need a diabetes diagnosis. You must also be in a TRICARE plan2. This includes active duty, retirees, and their families. No matter your TRICARE plan, you get many diabetes supplies and services.
Coverage Types and Options
TRICARE covers diabetes in two ways: pharmacy and medical. You can get test strips, lancets, and insulin from the pharmacy. For things like glucose monitors and insulin pumps, you use your medical benefits2.
Key Benefits Overview
TRICARE offers many benefits for diabetes care. You get test strips, lancets, and syringes. They also cover glucose meters, insulin pumps, and more. Plus, there’s diabetes training, eye exams, and special shoes to help manage your diabetes2.
Knowing about TRICARE’s diabetes coverage helps you use all the resources available. Whether you’re new to diabetes or have been managing it for years, TRICARE supports your health and well-being.
Essential TRICARE Diabetic Supplies and Equipment
| Diabetic Supply | TRICARE Coverage |
|---|---|
| Insulin products | Covered |
| Blood glucose strips | Covered |
| Blood and urine ketone/acetone test strips | Covered |
| Diabetic syringes and needles | Covered |
| Home glucose monitors | Covered as DME |
| Insulin infusion pumps (e.g., Omnipod 5) | Covered as DME |
| Diabetic socks | Covered |
TRICARE wants to help you manage your diabetes well. They provide essential supplies and equipment to support your health3.
“Diabetic retinopathy is the leading cause of blindness in working-age adults, according to the Centers for Disease Control and Prevention (CDC).”1
Pharmacy Benefits for Diabetes Management
TRICARE, the military health insurance program, offers several options for getting diabetic supplies. You can choose home delivery, retail network pharmacies, or military pharmacies. TRICARE covers all these options to help manage your diabetes4.
Military Pharmacy Options
Active-duty service members, retirees, and their families can get prescriptions at military pharmacies. These pharmacies have a wide range of diabetic products. They often offer these products at low or no cost, making them a great choice for TRICARE beneficiaries4.
Home Delivery Services
TRICARE also offers home delivery for your diabetic supplies. You can order online or by phone. Then, they ship your supplies to your home, often cheaper than retail pharmacies4.
Retail Network Pharmacies
TRICARE members can also get their supplies from retail pharmacies in the TRICARE Pharmacy Program. These pharmacies have a wide selection of products. They often have competitive prices4.
| Pharmacy Option | Key Advantages |
|---|---|
| Military Pharmacies | Wide selection of tricare diabetic supplies, low or no cost |
| Home Delivery Services | Convenient, often lower cost than retail pharmacies |
| Retail Network Pharmacies | Accessible, competitive pricing on tricare diabetic supplies |
Use the TRICARE Formulary Search Tool to find the supplies you need. It shows cost, coverage rules, and availability4.
If you’re a US Family Health Plan (USFHP) user, you must use USFHP pharmacies. You can’t use the TRICARE Pharmacy Program for your supplies4.
Continuous Glucose Monitoring Systems (CGMs) Coverage
To get CGM coverage through TRICARE, you need to take daily insulin. This can be through a pump or injections5. The cost depends on the prescription category, pharmacy type, and your TRICARE plan5. Active-duty members get prescriptions for free from military pharmacies, home delivery, and network pharmacies5.
| CGM Brand | TRICARE Coverage | Key Features |
|---|---|---|
| Abbott FreeStyle Libre 2 | Covered under TRICARE Pharmacy Program | Provides glucose readings every 5 minutes, transmitting data wirelessly to a handheld device or app6. |
| Dexcom G6 | Covered under TRICARE Pharmacy Program | Offers continuous glucose monitoring with a 10-15 minute delay in readings6. |
CGMs need a doctor’s approval to get through TRICARE, even if you’ve had it before5. You can order them from TRICARE retail pharmacies and the TRICARE Pharmacy Home Delivery service5. The amount you get depends on your doctor’s prescription5. Remember, CGM availability can differ by pharmacy, so it’s best to call ahead5.
US Family Health Plan (USFHP) members can’t use TRICARE Pharmacy Program for CGMs. They must go to USFHP pharmacy providers for their supplies5.
Insulin Delivery Systems and Pump Coverage
Omnipod 5 Coverage Details
To get coverage for the Omnipod 5 or other insulin systems, TRICARE members need prior authorization. This step checks if the device is medically needed and fits TRICARE’s rules. The TRICARE Formulary Search Tool helps find costs, coverage, and availability of these systems7.
“Diabetes supplies covered by the TRICARE Pharmacy Program include insulin products, blood glucose strips, diabetic syringes, needles, lancets, continuous glucose monitoring systems (CGMs), and more.”7
It’s important for people with diabetes to have the right insulin delivery system. Knowing about coverage and pre-authorization helps TRICARE members make good choices. They can work with their healthcare providers to find the best way to manage their diabetes.
Test Strips and Blood Glucose Monitoring
TRICARE makes sure you have what you need to check your blood sugar levels. This includes test strips, which are key for managing diabetes. TRICARE covers prescription drugs and supplies like insulin, blood glucose strips, and glucose monitoring devices1.
For TRICARE members, FreeStyle Lite and Precision Xtra test strips from Abbott Diabetes Care don’t need a prior approval. But, other brands need approval first. You must show you tried FreeStyle Lite and Precision Xtra strips1. The TRICARE Formulary Search Tool helps find out if your test strips and glucose monitoring devices are covered1.
| Test Strip Brand | Prior Authorization Required |
|---|---|
| FreeStyle Lite | No |
| Precision Xtra | No |
| Other Brands | Yes |
“TRICARE’s coverage for test strips and glucose monitoring devices helps ensure our beneficiaries have access to the tools they need to manage their diabetes effectively.”
Additional Diabetic Support Services
If you have diabetes and are in TRICARE, you get extra help. TRICARE covers a lot for diabetes care. This includes training, eye exams, and special shoes10.
Diabetes Self-Management Training
TRICARE pays for training if your doctor says you need it. This training teaches you to check your blood sugar and live healthy. It helps you manage diabetes every day10.
Eye Exam Coverage
Therapeutic Footwear Benefits
TRICARE knows how important good foot care is for diabetes. They pay for special shoes and inserts if your doctor prescribes them. This footwear helps avoid foot problems and keeps you moving1.
Using TRICARE’s extra services can help you manage your diabetes better. You can get diabetic socks, tricare diabetic supplies, and more. TRICARE wants to give you the best care for diabetes10.
“TRICARE’s diabetes management is a big help for military families. With training, eye exams, and special shoes, I can stay healthy and active with diabetes.”
| Service | Coverage Details |
|---|---|
| Diabetes Self-Management Training | Covered with a doctor’s referral, providing skills and plans for blood sugar monitoring and healthy lifestyle management. |
| Eye Exams | Covers medically necessary and routine eye exams to detect and manage diabetic retinopathy and other vision issues. |
| Therapeutic Footwear | Covers prescribed and fitted therapeutic shoes and inserts to prevent foot injuries and improve mobility. |
Prior Authorization and Documentation Requirements
Understanding tricare diabetic supplies and insulin delivery systems coverage can be tricky. Knowing the prior authorization and documentation needs is key. Some supplies and services under TRICARE need prior approval, like certain pharmacy items and glucose monitors. For test strips other than FreeStyle Lite and Precision, a healthcare provider must fill out a form and send it to Express Scripts11.
The paperwork needed can change based on the supply or service. It’s vital to keep up with TRICARE’s latest rules. This way, you can make sure your claims are handled smoothly11.
- Providers can prove a drug’s need by calling Express Scripts at 1-866-684-448811.
- Active duty members need a doctor’s approval for non-formulary drugs11.
- Family members and retirees pay more for non-formulary drugs11.
- Providers can ask for exceptions for age or quantity limits by calling Express Scripts at 1-866-684-448811.
- Some medications on the Formulary Search Tool may need medical necessity forms or prior authorizations11.
- Providers can appeal denied drugs through Express-Scripts Customer Service at 1-877-363-130311.
- The copay for medications on the Formulary Search Tool shows an approved prior authorization11.
- Generic drugs are preferred over branded ones, unless a doctor says otherwise11.
- Military pharmacies usually don’t have non-formulary drugs11.
It’s crucial to stay informed and work closely with your doctor. This ensures you meet all the requirements for tricare diabetic supplies and insulin delivery systems. By understanding these processes, you can better navigate the TRICARE system. This way, you can get the care and equipment you need1.
As of Feb. 15, TRICARE covers the Omnipod 5 insulin delivery device under the pharmacy benefit, requiring pre-authorization from a doctor1. Some diabetes products covered by the pharmacy benefit may necessitate pre-authorization from Express Scripts, such as getting a Continuous Glucose Monitoring system from the pharmacy1.
Diabetes complications can lead to blindness; TRICARE covers medically necessary eye exams for individuals with diabetes on top of routine eye exam coverage1. Therapeutic shoes and inserts are covered by TRICARE when prescribed and fitted by qualified providers to help prevent foot injuries and improve mobility1.
| TRICARE Diabetic Supplies and Services | Prior Authorization Required |
|---|---|
| Continuous Glucose Monitoring (CGM) Systems | Yes |
| Insulin Delivery Devices (e.g., Omnipod 5) | Yes |
| Test Strips (other than FreeStyle Lite and Precision Xtra) | Yes |
| Therapeutic Footwear | Yes |
Conclusion
TRICARE offers full coverage for tricare diabetic supplies, glucose monitoring devices, and insulin pumps. This means people with diabetes can get the tools they need to manage their condition well. During the COVID-19 pandemic, TRICARE made changes to help more people get care. This includes covering telephonic visits and more hospital stays.
TRICARE also has a wide range of pharmacies and providers. This makes it easy to get the diabetic care you need. You can choose from military pharmacies, home delivery, or retail stores.
TRICARE has approved continuous glucose monitoring systems (CGMs) for Type 1 diabetes. The P&T Committee made sure CGMs are affordable through the pharmacy benefit12. They are now part of the Uniform Formulary drugs.
TRICARE also covers insulin delivery systems, test strips, and other diabetic supplies. This makes it a great resource for managing diabetes.
Knowing what TRICARE covers can help you make better choices for your diabetes care. TRICARE wants to help its members live healthier lives. They aim to make managing tricare diabetic supplies, glucose monitoring devices, and insulin pumps easier.
FAQ
What diabetic supplies and equipment does TRICARE cover?
TRICARE covers many diabetes supplies and equipment. This includes insulin, blood glucose strips, and diabetic syringes. They also cover needles, lancets, and continuous glucose monitoring systems (CGMs).
Who is eligible for TRICARE’s diabetic coverage?
You need a diabetes diagnosis and a TRICARE plan to get coverage. This is the basic requirement.
How can I obtain diabetic supplies through TRICARE?
You can get diabetic supplies through TRICARE in several ways. You can visit military pharmacies, use home delivery services, or go to TRICARE retail network pharmacies.
Does TRICARE cover continuous glucose monitoring systems (CGMs)?
Yes, TRICARE covers CGMs under the pharmacy benefit. You might need a doctor’s pre-authorization for this.
What insulin delivery systems are covered by TRICARE?
TRICARE now covers the Omnipod 5 insulin delivery device. This is under the pharmacy benefit. You’ll need a doctor’s pre-authorization for it.
Which blood glucose test strips are covered by TRICARE?
TRICARE covers FreeStyle Lite and Precision Xtra test strips without needing prior authorization. But, other test strips might need prior authorization and proof of trying those brands first.
What additional support services does TRICARE offer for diabetes management?
TRICARE offers more than just supplies. They cover diabetes self-management training and eye exams for diabetics. They also cover therapeutic shoes and inserts when a doctor prescribes them.
Yes, some supplies and services need prior authorization. This includes certain pharmacy benefit products and continuous glucose monitoring systems. You’ll need a healthcare provider’s approval.
Source Links
- Have Diabetes? Check Supplies, Services TRICARE Covers – https://newsroom.tricare.mil/News/TRICARE-News/Article/3311965/have-diabetes-check-supplies-services-tricare-covers
- TRICARE Tips for Managing Diabetes and Your Oral Health – https://health.mil/News/Dvids-Articles/2024/07/03/news475524?page=17
- Have Diabetes? Check Supplies, Services TRICARE Covers – https://myarmybenefits.us.army.mil/News/Have-Diabetes-Check-Supplies-Services-TRICARE-Covers
- The Health Insurance Marketplace & People with Diabetes – https://diabetes.org/tools-resources/health-insurance-support/health-insurance-marketplace-people-diabetes
- Continuous glucose monitors now available as a TRICARE pharmacy benefit – https://www.349amw.afrc.af.mil/News/Article-Display/Article/3073280/continuous-glucose-monitors-now-available-as-a-tricare-pharmacy-benefit/
- Continuous glucose monitors: What are they and how can they help better manage diabetes? | Express Scripts – https://www.express-scripts.com/pharmacy/blog/continuous-glucose-monitors
- Have Diabetes? Check Supplies, Services TRICARE Covers – https://nhc-charleston.tricare.mil/News-Gallery/Articles/Article/3311965/have-diabetes-check-supplies-services-tricare-covers
- Tricare now covers new costly insulin device for Type 1 diabetics – https://www.militarytimes.com/pay-benefits/military-benefits/health-care/2023/03/01/tricare-now-covers-new-costly-insulin-device-for-type-1-diabetics/
- Tricare Is Now Providing Better Blood Sugar Monitors for Type 2 Diabetics – https://www.military.com/daily-news/2020/01/29/tricare-now-providing-better-blood-sugar-monitors-type-2-diabetics.html
- Financial Help for Diabetes Care – NIDDK – https://www.niddk.nih.gov/health-information/diabetes/financial-help-diabetes-care
- TRICARE Formulary – https://health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/Pharmacy-Operations/TRICARE-Formulary
- BAP Background Document for the November 2021 DoD Committee Meeting – https://health.mil/Reference-Center/Meeting-References/2022/01/12/Background-Information-November-2021