FALLS CHURCH, Va. –
The
shortage of baby formula is having an impact on millions of families. This includes military families living in the U.S. and overseas. It’s important you know what TRICARE does and doesn’t cover. Here are a few questions and answers about infant formula coverage to help.
“The formula shortage is a concerning and challenging situation and one that the Defense Health Agency is taking seriously,” said Elan Green, chief of TRICARE Health Plan’s Member Benefits and Reimbursement Section. “We understand that parents are worried. We know that clear information can help you navigate this difficult time.”
Q: Does TRICARE cover baby formula?
A: TRICARE covers baby formula that’s medically necessary. This includes:
- Regular infant formula for children who have feeding tubes (separately, TRICARE also covers specialized formulas for adults or older children with feeding tubes or who can’t eat solid foods)
- High-protein formula for infants on ketogenic diets to control seizures
- Special formulas for those who can’t digest certain foods or nutrients
Your child’s doctor must diagnose and prescribe a special formula.
Note: TRICARE doesn’t cover formula for healthy infants and children.
Q: Who is eligible to get medically necessary formula?
A: If you meet conditions of coverage on medical foods, TRICARE may cover your specialty formulas or other medical foods. Remember that care must be medically necessary and appropriate. You can review the kinds of medically necessary foods that TRICARE covers by checking out the
Nutritional Therapy page. The type of formula depends on the medical need.
Q: Does TRICARE ship formula?
A: No. TRICARE doesn’t directly ship formula to families.
Q: How much does the prescribed formula cost?
A: Your costs for covered medical foods depend on your health plan. It also depends on your beneficiary category. Visit the
TRICARE Costs page and look under “Medical Supplies” to learn more.
Q: What if I can’t get my baby’s prescription formula?
A: If you have a child whose medically necessary formula is unavailable, you should work with your pediatrician, primary care manager (PCM), or specialist such as a pediatric registered dietitian. TRICARE will cover your appointments to talk about options for your child.
Q: What suggestions are there for parents trying to feed their infants?
A: Do not attempt to make your own formula. The
Food and Drug Administration (FDA) “advises parents and caregivers to not make or feed homemade infant formula to infants. Homemade infant formula recipes have not been evaluated by the FDA and may lack nutrients vital to an infant’s growth … The agency has received reports of hospitalized babies who had been fed homemade infant formula … which can be life-threatening.” The FDA recommends asking your child’s pediatrician, PCM, or specialist for guidance on changing your child’s formula or feeding practices. You can go to the FDA website to find other
recommendations and warnings for parents trying to find formula.
The
American Academy of Pediatrics also encourages you to talk with your child’s doctor if you have any concerns about your baby’s health and nutrition. If your child has special health needs, be sure to check with their doctor about medically appropriate and safe feeding alternatives.
“We understand that this is a very stressful time for military families with babies,” said Green. “Because TRICARE doesn’t have a supply of infant formula, it’s best you consult with your pediatrician, PCM, or specialist.”
If you have questions about TRICARE covered services or costs, you can refer to the
TRICARE website. You can also reach out to your
TRICARE regional contractor for more information. Remember that your best resource for guidance and advice on your options is your child’s health care provider.
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