Tricare restores coverage for some genetic lab tests

The Defense Health Agency, relying on medical laboratory experts and existing authority to conduct medical “demonstrations,” will restore TRICARE coverage this month for up to 40 genetic tests used in patient care. Many of these laboratory-developed tests — also called molecular pathology tests — are viewed as medically necessary. But TRICARE had stopped reimbursing for more than 100 such tests in January 2013, believing it lacked authority to pay for them when such tests are ordered by civilian physicians delivering care through TRICARE provider networks. Starting July 18th, “30 to 40” genetic tests, those “most commonly performed” across U.S. medicine, will become reimbursable again under TRICARE, as part of a three-year medical demonstration project. Among genetic tests to be restored to TRICARE coverage is one that determines if a woman who is pregnant, or desires to become pregnant, carries a genetic marker for cystic fibrosis. That marker would indicate increased risk that a newborn would have CF. A full list of genetic testing to be approved for TRICARE hasn’t been released yet. But coverage will be retroactive to Jan. 1, 2013, so laboratories and patients will be able to apply for reimbursements of newly-cleared tests that they had paid for back to that date. TRICARE will seek to hold down costs by using military labs with genetic testing capability when possible. Such labs now operate at military medical centers in Texas, Mississippi and Washington states.