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News | Feb. 27, 2023

Have Diabetes? Check Supplies, Services TRICARE Covers

By TRICARE Communications

If you have diabetes, you know managing it well is vital to you staying healthy from head to toe. And from medical appointments to glucose monitoring and more, TRICARE can help you live your healthiest life with diabetes.
 
“There’s no one-size-fits-all approach to diabetes care, and that’s why TRICARE covers a variety of diabetes supplies and services,” said Lt. Cmdr. Giao Phung, a clinical pharmacist with the Pharmacy Operations Division at the Defense Health Agency. “Learning about these benefits can help you make informed health decisions for yourself or a family member with diabetes.”
 
Here’s a look at some of the benefits available to you.
 
Diabetes Drugs, Supplies, and Equipment
TRICARE covers prescription drugs and related supplies and equipment to help you manage your diabetes. Depending on your needs, diabetes supplies and equipment may fall under your pharmacy benefit, your medical benefit, or both.
 
Supplies covered by the TRICARE Pharmacy Program include:
  • Insulin products
  • Blood glucose strips
  • Blood and urine ketone/acetone test strips
  • Diabetic syringes, needles, and lancets
  • Continuous glucose monitoring systems (CGMs)
 
As of Feb. 15, TRICARE covers the Omnipod 5 insulin delivery device under your pharmacy benefit. You must have pre-authorization from your doctor. Right now, you can only get the device at a retail pharmacy. To find the cost, coverage rules, and availability of this device and other products and brands, check the TRICARE Formulary Search Tool. You may find some products available at military pharmacies, through home delivery, or at TRICARE retail network pharmacies. Remember, if you use the US Family Health Plan (USFHP), you must use a USFHP pharmacy provider. When you have USFHP, you can’t use the TRICARE Pharmacy Program.
 
For some products covered by your pharmacy benefit, your doctor may need to request pre-authorization from Express Scripts. This includes getting a CGM from your pharmacy, even if you’ve received approval for one under your medical benefit.
 
Depending on how your prescription is written, a CGM may be covered as durable medical equipment (DME) by your medical benefit. Home glucose monitors and insulin infusion pumps may also be covered as DME under certain conditions.
 
Diabetes Self-Management Training
Do you need help learning how to manage your diabetes? If you’re eligible, your doctor can refer you to diabetes self-management training. In this outpatient program, you’ll learn skills and develop a plan for monitoring your blood sugar and maintaining a healthy lifestyle. You may also qualify for follow-up training each year.
 
Eye Exams
Did you know diabetes can harm your eyes? In fact, diabetic retinopathy is the leading cause of blindness in working-age adults, according to the Centers for Disease Control and Prevention (CDC). If you have diabetes, TRICARE covers medically necessary eye exams. And this is in addition to routine eye exam coverage.
 
Therapeutic Shoes
If you have diabetes, your feet need you to take care of them daily. Be sure to pay attention to how your feet look and feel, and follow CDC tips for healthy feet. You may also need therapeutic shoes and inserts to help you prevent foot injuries and improve your mobility. TRICARE covers shoes and inserts when prescribed and fitted by qualified providers.
 
Want to learn more? Check out health habits for people with diabetes from the Military Health System.
 
Do you have questions about what’s covered? You can contact Express Scripts with questions about your pharmacy benefit. For supplies and services covered by your medical benefit, call your regional contractor.
 
Would you like the latest TRICARE news sent to you by email? Visit the TRICARE Subscriptions page today, and create your personalized profile to get benefit updates, news, and more.
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