Does TRICARE cover an insulin pump?

Yes, for certain kinds of diabetes. TRICARE covers insulin infusion pumps for insulin-dependent type 1 diabetes with poor diabetic control, for cystic fibrosis-related diabetes, and for type 2 diabetes with poor control documented after six months of multiple daily injections. The pump must be prescribed by a TRICARE-authorized provider; insulin comes through the pharmacy.

Steps

1. Talk with the doctor. The doctor decides whether a pump fits your care and which one.
2. Which diabetes qualifies. TRICARE names insulin-dependent type 1 diabetes with poor diabetic control, cystic fibrosis-related diabetes, and type 2 diabetes with poor control documented after six months of multiple daily injections.
3. Get the order. The pump must be prescribed by a TRICARE-authorized provider, with the diagnosis documented.
4. Approval from TriWest. In the West, TriWest reviews equipment before it's approved. Intake helps you gather what's needed.
5. Insulin is separate. Insulin comes through your pharmacy benefit, not with the pump.
6. Training first. Learn the pump with your care team before you start using it at home.

Checklist

• Doctor agrees a pump fits your care
• Diagnosis documented the way TRICARE names it
• Order from a TRICARE-authorized provider
• Insulin set up through the pharmacy
• Pump training planned
• Called intake or sent a request

In TRICARE's words

Insulin-dependent type 1 diabetes and a diagnosis of poor diabetic control

Diabetes Supplies and Equipment — tricare.mil

Cystic fibrosis-related diabetes

Diabetes Supplies and Equipment — tricare.mil

Type 2 diabetes with a documented diagnosis of poor diabetic control and a documented failure to achieve glycemic control after six months of multiple daily injection therapy

Diabetes Supplies and Equipment — tricare.mil

Items must be prescribed by a TRICARE-authorized provider.

Diabetes Supplies and Equipment — tricare.mil

Equipment in this guide

• Insulin Pump
• Continuous Glucose Monitor