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New TRICARE® Coverage for Banked Donor Milk

Friday, May 17, 2019

TRICARE now covers prescribed banked donor milk for infants with serious health conditions. Coverage applies if the mother’s milk is unavailable or the quantity produced is not sufficient, and the infant has one or more of the following conditions: 

  • Very low birth weight; 
  • A digestive disorder or surgery requiring additional support; 
  • Diagnosed with failure-to-thrive where other feeding options have been unsuccessful; 
  • Intolerance to formula with documented feeding difficulty or weight loss;
  • Low blood sugar; 
  • Heart disease; 
  • Organ transplant; or  
  • Other serious health conditions when the use of banked donor milk is medically necessary for the treatment and recovery of the infant

Beneficiaries must have a prescription from the infant’s treating TRICARE-authorized provider that specifies the banked donor milk quantity and frequency needed. Initial prescriptions are valid for 30 days, and coverage is limited to no more than 35 ounces per day, per infant. Coverage may be extended in 30-day intervals through 12 months of age, when medically necessary and with a new prescription. 

Covered donor milk must come from human milk banks accredited by the Human Milk Banking Association of North America (HMBANA). Visit www.hmbana.org/find-a-milk-bank for the current list of HMBANA-accredited milk banks. Human milk banks interested in joining the HNFS West Region provider network can visit our Become a TRICARE Provider page and follow the instructions for ancillary providers. Milk banks who wish to participate as non-network may complete a non-network provider application, available on our Non-Network Provider Forms page. 

Prior authorization is not required; however, all beneficiaries must meet the coverage criteria listed above. Banked donor milk suppliers should work closely with the prescribing provider to ensure all required medical documentation is received. HNFS offers a Banked Donor Milk Coverage Criteria Attestation form which can be completed by the prescribing provider and submitted with the claim. Visit our Banked Donor Milk page to access this form and for additional benefit details.