Diabetic Supplies and Equipment
- insulin products*
- blood and urine glucose test strips
- blood and urine ketone/acetone test strips
- diabetic syringes and needles*
These supplies are covered by the TRICARE pharmacy benefit and may be obtained from a military treatment facility pharmacy, through TRICARE Pharmacy Home Delivery or at any TRICARE retail pharmacy. Prescription copayments will apply and out of pocket costs will be higher when using a non-network pharmacy.
*Medicare Part B does not cover insulin (unless used with an insulin pump) and diabetic syringes/needles; the TRICARE pharmacy benefit is the primary payer for these items.
The following diabetic equipment is covered under the TRICARE medical program as durable medical equipment:
- Home glucose monitors
- Continuous glucose monitor systems (CGMSs). CGMSs are a limited benefit and may be covered when FDA approved.
- A therapeutic CGMS is defined as a device that is approved by the FDA for non-adjunctive use (for example, used as a replacement for fingerstick testing). Therapeutic CGMS devices and all related supplies shall be reported using HCPCS codes K0553–K0554.
- A non-therapeutic CGMS is defined as a device that is approved by the FDA for use to complement, not replace, information obtained from fingerstick testing. Non-therapeutic CGMS devices and all related supplies shall be reported using HCPCS codes A9276, A9277 and A9278.
- Therapeutic and non-therapeutic devices and supplies may not be billed on the same claim.
Note: In addition to being available under TRICARE’s DME benefit, TRICARE covers the FreeStyle Libre 2 and the Dexcom G6 CGMSs as a brand-name formulary pharmacy benefit under the TRICARE Pharmacy Program managed by Express Scripts®. If obtaining under the phrmacy benefit, prescribers must request prior authorization by contacting Express Scripts at 1-866-684-4488 or faxing a completed prior authorization form to 1-866-684-4477. Search for “FreeStyle Libre 2” or “Dexcom G6” in Express Scripts’ formulary tool at www.militaryrx.express-scripts.com.
- Insulin infusion pumps for beneficiaries with:
- Insulin-dependent type 1 diabetes mellitus when there is documentation by the physician of poor diabetic control.
- Cystic fibrosis related diabetes.
- Type 2 diabetes when there is documentation by the physician of poor diabetic control and the patient has failed to achieve glycemic control after six months of multiple daily injection therapy.
To expedite the review process, providers may attach a Letter of Attestation in lieu of clinical documentation to the authorization request.
See also Diabetes Outpatient Self-Management Training and Orthotics for additional diabetic services covered.
For additional information on diabetes education including definitions, symptoms and ways to manage this diagnosis, please visit our Diabetes Education page.