If you’re using a continuous glucose monitor (CGM), you’re in luck. The TRICARE Pharmacy program now includes two brands of CGMs. These are the Abbott FreeStyle Libre 2 and the Dexcom G6. Previously, CGMs were only available as durable medical devices (DME) under the TRICARE medical benefit. CGMs continue to be covered as a medical reimbursement for DME, but they are now also available as part of your pharmacy benefit.
“This change in expanded reimbursement coverage will improve access for patients to get the CGMs they need,” said Edward VonBerg, PharmD, chief of the Defense Health Agency’s Formulary Management Branch. “We strive to make TRICARE benefits as accessible and affordable as possible so that beneficiaries feel good and can lead healthy, productive lives. Adding CGMs to the pharmacy benefit is an example of that.”
As a pharmacy benefit, CGMs are available through the TRICARE retail network pharmacies and the TRICARE Pharmacy Home Delivery. As described in the Overview TRICARE Pharmacy ProgramActive duty members pay nothing for covered prescriptions from:
For everyone else, pharmacy charges are based on who you are, the prescription category, and where you fill your prescription.
You need a pre-authorization to receive both brands of CGM through the TRICARE Pharmacy Program. This applies even if you are already approved through the TRICARE medical benefit. To be pre-authorised, you must require daily insulin through a pump or multiple daily injections. Pharmacies dispense the devices in limited quantities, based on your supplier’s written prescription.
If you choose to collect your CGM from a network pharmacy or have it delivered to your home, each part will be charged at the branded drug rates.
Your TRICARE plan, which group you are in (A or B) and the type of pharmacy determine whether you may need to meet your annual deductible before co-payments or cost-sharing apply. Use the TRICARE Compare Cost Tool for more information.
Before going to your pharmacy, call to confirm the availability of the CGM you need. Some facilities stock one, both and none of the devices. Be sure to bring your health care provider’s prescription when you pick up your CGM.
If you choose home delivery for the Abbott FreeStyle Libre 2 reader, you must order the reader through the Department of Defense’s Abbott Labs FreeStyle Libre program, which is a free service. Call 904-638-5519 for information. You can also get the Abbott FreeStyle Libre 2 reader from a network pharmacy.
You can order Dexcom G6 components through home delivery. Dexcom G6 devices can also be picked up from network pharmacies.
Keep in mind that both products have free smartphone applications that you can use in lieu of the devices’ readers.
Remember, you can still get your CGM as a DME through the TRICARE medical benefit. It depends on how your provider writes your prescription. Your TRICARE health plan determines your reimbursements. If you have coverage through the United States Family Health Plan (USFHP), you are not eligible for the TRICARE Pharmacy program. You must use USFHP pharmacies.
If you have any questions about services or fees covered by TRICARE, please visit the TRICARE website. You can also contact your regional contractor or the pharmacy contractor.
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