Does TRICARE cover a continuous glucose monitor?
Yes for some conditions. Two routes: medical equipment or the pharmacy.
Does TRICARE cover a continuous glucose monitor?
TRICARE's answer is "Yes for some conditions. Monitors must be FDA-approved." As medical equipment, the doctor must document poor diabetic control after six months of insulin injections or pump therapy, self-testing at least four times a day, and a finished diabetes education program. You can also get one through the pharmacy, with prior authorization.
A continuous glucose monitor reads blood sugar day and night, so you see where your numbers are heading. TRICARE covers one when the doctor documents certain conditions.
Steps
- Talk with the doctor. The doctor decides whether a continuous glucose monitor fits your care, and which one.
- What the doctor documents. As medical equipment, TRICARE needs the doctor to document poor diabetic control after six months of insulin injections or pump therapy, self-testing at least four times a day, and a finished diabetes education program.
- Pick a route. You can get a monitor as medical equipment from a TRICARE-authorized supplier, or through the pharmacy. What you pay depends on the route.
- The pharmacy route. At a pharmacy you need prior authorization, even if you were already approved under the medical benefit.
- The equipment route. In the West, TriWest reviews equipment before it's approved. Intake helps you gather what's needed.
- TRICARE For Life. If you have TRICARE For Life and live in the U.S. or a U.S. territory, Medicare's rules apply too.
Checklist
- Doctor agrees a monitor fits your care
- Six months of injections or pump therapy documented
- Testing four times a day documented
- Diabetes education program finished
- Chose the equipment route or the pharmacy route
- Called intake or sent a request
Strips, lancets and insulin come through the pharmacy, not with the monitor.
In TRICARE's words
Yes for some conditions. Monitors must be FDA-approved. You may get an approved continuous glucose sensor and transmitter using your pharmacy or medical benefit. What you pay depends on the option you use.
Does TRICARE cover continuous glucose monitors? — tricare.mil
Poor diabetic control after six months of multiple daily insulin injections or insulin pump therapy
Blood glucose self-testing at least four times a day
Completion of a diabetes education program
You need prior authorization to get a continuous glucose monitor at a pharmacy, even if you’ve received approval under your medical benefit.
Equipment in this guide
Follow the instructions from your doctor and the equipment maker.