Insurance - TRICARE

Deborah · December 31, 2015, 08:22:00 AM

Is there anybody else here covered by TRICARE PRIME? If there is have you successfully used it to cover pharmacy costs for HRT?

I have been reading elsewhere that some have and the costs were not denied.

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TechGirl · December 31, 2015, 08:44:13 PM

Not sure about tricare. They should cover it like any other prescription. Also, Veterans Affairs has made announcements that they will support transgender.

Deborah · December 31, 2015, 08:52:18 PM

Yes, VA will cover it but it's an entirely separate program from TRICARE and I think I would have to start all over in their system.

I think this month I'll try billing it to TRICARE and see what happens. The diagnosis it was prescribed under was for endocrine disorder, testicular hypofunction, and benign hypertension so maybe that won't trip any keywords to cause a denial.

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Mariah · December 31, 2015, 08:57:27 PM

Deborah as long as the right diagnosis codes are down they won't challenge it. Now because it is a federal based insurance plan they may need to use codes related to hormonal imbalance to get it covered. I deal with tricare on my mom, but not me. Hugs
Mariah

WendyA · December 31, 2015, 10:15:20 PM

I just started hrt and used Tricare's mail order pharmacy without a problem. You can look up drugs on Tricare's pharmacy site, they say for estradiol and Spiro no justification is required. Now blood tests and labs may be a different story. The clinic I went doesn't file with Tricare and I didn't file for reimbursement.

Deborah · December 31, 2015, 10:18:45 PM

For my next blood test I'm going to try and get my endo to fax or send me the blood test order and I'll try and have it done at a nearby Army Hospital. Other than measuring the estradiol level the rest is all just standard bloodwork.

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Deborah · December 31, 2015, 10:51:16 PM

Yaaaaay, but I feel like an idiot now. I just looked up all three prescriptions on the formulary and I do qualify. $24 copay from the pharmacy or $0 copay mail order. That lowers my monthly cost by at least $126.

All this time I assumed it wasn't covered.

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TechGirl · January 01, 2016, 12:04:30 AM

Quote from: Deborah on December 31, 2015, 10:51:16 PM
Yaaaaay, but I feel like an idiot now. I just looked up all three prescriptions on the formulary and I do qualify. $24 copay from the pharmacy or $0 copay mail order. That lowers my monthly cost by at least $126.

All this time I assumed it wasn't covered.

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Good to know. I'm still at the beginning of my journey, but I have not ruled out hrt and tricare prime is my insurer.

WendyA · January 02, 2016, 10:57:18 AM

Quote from: Deborah on December 31, 2015, 10:51:16 PM
Yaaaaay, but I feel like an idiot now. I just looked up all three prescriptions on the formulary and I do qualify. $24 copay from the pharmacy or $0 copay mail order. That lowers my monthly cost by at least $126.

I was pleasantly surprised as well. I looked them up prior to scheduling HRT then had the clinic fax in the prescription (I provided them with the form downloaded from online with my health benefits number and address already written on the form). There were some minor communication glitches, but within 10 days from the prescription being placed I had the HRT in my hands.

Deborah · January 02, 2016, 10:59:42 AM

I think something must have changed because I could swear I looked this up a year or two ago and it was pretty explicitly excluded.

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Deborah · January 17, 2016, 05:33:57 AM

I got my prescription refilled yesterday at Walmart and TRICARE did pay for it without any issues at all. That lowered my cost from $150 to $24 so it's a whole lot less painful on my bank account now.

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Emily-G · January 17, 2016, 04:39:33 PM

This is good to know.

I've registered with the VA and have an ID etc... But I'm not sure if this is considered Tricare Prime or just the VA standard insurance.

I didn't retire out, so perhaps that is the difference.

Deborah · January 17, 2016, 05:34:14 PM

The VA is a separate medical system but I know that it does cover HRT. I'm not sure if you have to have it prescribed from the VA though.

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Harley Quinn · January 19, 2016, 12:00:36 PM

Tricare is offered for the first 6 months after you get off active duty. Then it's VA. If you go to the VA, you can continue with HRT as continuing care. If you aren't currently on HRT, the VA will send you to a gender therapist before they do anything.

WendyA · January 20, 2016, 03:08:38 AM

Quote from: Deborah on January 17, 2016, 05:33:57 AM
I got my prescription refilled yesterday at Walmart and TRICARE did pay for it without any issues at all. That lowered my cost from $150 to $24 so it's a whole lot less painful on my bank account now.

Deborah I know that has to feel great. I am so glad to see other veterans here speaking up and letting others know that they are not alone.

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Insurance - TRICARE

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