FALLS CHURCH, Va. — TRICARE is expanding its coverage of laboratory-developed tests under a new demonstration program.
The Defense Health Agency’s demonstration project allows TRICARE to review tests not examined by the FDA to determine if they are safe and effective for use. This demonstration also includes coverage for prenatal and preconception cystic fibrosis carrier screenings, with certain limitations.
Generally, TRICARE covers only medications and medical devices like laboratory-developed tests that are reviewed and approved by the FDA. The demonstration allows the Department of Defense to perform its own evaluation of a laboratory-developed test, establish a list of these tests deemed safe and effective and establish a process to add new tests to that list.
TRICARE will maintain and publish a list of approved tests and will update it continually as new tests are reviewed and approved for coverage. The regional contractor must preapprove use of the test for it to be covered.
Beneficiaries who have paid for laboratory-developed tests since Jan. 1, 2013, and who are now included in the demonstration are eligible for retroactive reimbursement. Additional details about retroactive payments will be forthcoming.
The demonstration will be an ongoing process, allowing the Military Health System to respond to patient needs and ensure better consistency in the level of care that is available at military hospitals and through TRICARE health-plan options.