TRICARE Non-Coverage of LDTs

In January of last year, TRICARE, the health care program for military service members, retirees and their families, ceased coverage of over 100 laboratory developed tests (LDTs) when these tests are ordered by physicians in the civilian provider network. These tests, which historically have been covered by TRICARE, play a critical role in the diagnosis…

In January of last year, TRICARE, the health care program for military service members, retirees and their families, ceased coverage of over 100 laboratory developed tests (LDTs) when these tests are ordered by physicians in the civilian provider network. These tests, which historically have been covered by TRICARE, play a critical role in the diagnosis and treatment of disease, and include tests for Fragile X syndrome, Cystic Fibrosis, Spinal Muscular Atrophy, and many common cancers. TRICARE’s lack of coverage of these tests places TRICARE out of step with other government programs and commercial health insurance. This two tiered policy has also resulted in unequal treatment of TRICARE beneficiaries, with those obtaining care on base at Military Treatment Facilities maintaining access to these tests, while beneficiaries seeking care from the civilian provider network are denied critical testing services.

Despite acknowledging the important role of LDTs in healthcare delivery, the Defense Health Agency has denied coverage of these vital services for over a year. In many cases, laboratories have continued to provide testing services for TRICARE patients, and are awaiting payment. In other cases, TRICARE beneficiaries have been forced to absorb the cost of testing.

ACLA urges the Defense Health Agency to reinstate TRICARE coverage of these critical diagnostic tests so that military families can continue to access the best possible care.

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