Injection and infusion medication is a limited benefit. TRICARE covers medications that are approved by the U.S. Food and Drug Administration.
Injection/infusion medications may be administered:
- In the home by self or caregiver.
- In the home by a home health agency.
- In a provider’s office.
- In another outpatient setting such as an outpatient hospital or ambulatory infusion center.
Providers may buy and bill medication for outpatient administration or obtain it through a specialty pharmacy (specialty drug supplier). If the pharmacy supplies the medication to the provider’s office, they would subsequently bill Health Net Federal Services, LLC for reimbursement. Specialty drug suppliers can be located using our Network Provider Directory. Providers can submit a request for benefit review to determine coverage.
See our Home Infusion Therapy benefit for information on injection/infusion in the home.
See our Injectables Billing Tips for reimbursement information.
Prior Authorization Requirements
Prior authorization is required for home infusion for all beneficiaries. Prior authorization is not required for injection / infusion medication when it is provided in a provider's office or other outpatient setting, unless the beneficiary is an active duty service member.
If covered, the setting where the services are provided will determine costs; an outpatient office, ambulatory surgery setting or a home setting.