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NEWS | June 21, 2022

Continuous glucose monitors now available as a TRICARE pharmacy benefit

TRICARE Communications

If you use a continuous glucose monitor, or CGM, you’re in luck. TRICARE Pharmacy Program now covers two brands of CGMs. These are the Abbott FreeStyle Libre 2 and the Dexcom G6.

Previously, CGMs were only available as durable medical equipment (DME) under the TRICARE medical benefit. CGMs continue to be covered as a DME medical benefit, but they’re also now available as part of your pharmacy benefit.
 
“This change in expanded benefit 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 aim to make TRICARE benefits as accessible and affordable as possible so beneficiaries feel good and can lead healthy, productive lives. Adding CGMs to the pharmacy benefit is an example of this.”
 
As a pharmacy benefit, CGMs are available through TRICARE retail network pharmacies and TRICARE Pharmacy Home Delivery. As outlined in the TRICARE Pharmacy Program Overview, active duty service members pay nothing for covered prescriptions from:

For all others, pharmacy costs are based on who you are, the prescription category, and where you fill your prescription.
 
You need pre-authorization to get either brand of CGM through the TRICARE Pharmacy Program. This is true even if you’re already approved through the TRICARE medical benefit. To be pre-authorized, you must require daily insulin via a pump or multiple daily injections. Pharmacies dispense the devices in limited quantities, based on your provider’s written prescription.
 
If you choose to pick up your CGM at a network pharmacy or through home delivery, you’ll be charged for each component at the brand-name formulary drug rates.
 
Your TRICARE plan, which group you’re in (A or B), and pharmacy type determine whether you may have to meet your annual deductible before copayments or cost-shares apply. To learn more, use the TRICARE Compare Cost Tool.
 
Before you go to your pharmacy, you should first call to confirm availability of the CGM you need. Some facilities may stock one, both, and none of the devices. When you pick up your CGM, be sure to take the prescription from your health care provider with you.
 
If you choose home delivery for the Abbott FreeStyle Libre 2 reader, you must order the reader through the Department of Defense Abbott Labs FreeStyle Libre Program, which is a free service. For information, call 904-638-5519. You can also get the Abbott FreeStyle Libre 2 reader at a network pharmacy.
 
You can order Dexcom G6 components through home delivery. Dexcom G6 devices are also available for pick up at network pharmacies.
 
Keep in mind that both products have free smartphone applications you can use instead of the devices’ readers.
 
Remember that you can still get your CGM as DME through the TRICARE medical benefit. It depends on how your provider writes your prescription. Your TRICARE health plan will determine your fees. If you have coverage through US Family Health Plan (USFHP), you aren’t eligible for the TRICARE Pharmacy Program. You must use USFHP pharmacy providers.
 
If you have questions about TRICARE covered services or costs, you can refer to the TRICARE website. You can also reach out to your regional contractor or the pharmacy contractor.