TRICARE to Restore Coverage for Some Lab Developed Tests

Coverage for up to 40 lab developed tests (LDTs) will be restored under a new Defense Health Agency (DHA) demonstration program. The demonstration project also extends coverage for prenatal and preconception cystic fibrosis carrier screening. Our Association appreciates that DHA has taken this step to ensure that military families have access to safe and effective diagnostic genetic tests.

In January, 2013, without notice to beneficiaries or health care providers, TRICARE stopped reimbursing clinical laboratories for more than 100 lab developed tests when care was obtained from the TRICARE civilian provider network. Testing services for TRICARE beneficiaries accessing health care at military treatment facilities were not affected. Examples of the affected services include tests for Cystic Fibrosis, Fragile X Syndrome, and other tests used in the diagnosis and treatment of leukemia, lung, and other cancers. 

A full list of diagnostic genetic tests to be approved by TRICARE has not been released yet, but coverage will be retroactive to January 1, 2013. Beneficiaries will be able to apply for reimbursement, although details on that process have not yet been released.

Our Association advocated for almost a year to change TRICARE’s LDT policy. We attended numerous meetings with Congressional offices and raised the issue with DHA at every opportunity. During our advocacy work, many military families told us how they were negatively affected by TRICARE’s coverage denials. We are gratified by this new development will continue to monitor this issue as DHA implements the demonstration project.

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