TRICARE Launches New Laboratory Developed Test Demonstration

TRICARE is expanding its coverage of laboratory developed tests under a new demonstration program. Generally, TRICARE covers only medications and medical devices like laboratory developed tests reviewed and approved by the FDA. The demonstration allows the Defense Department 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 continually update it as new tests are reviewed and approved for coverage. The regional contractor must pre-approve use of the test for it to be covered. This demonstration also includes coverage for prenatal and preconception cystic fibrosis carrier screening, with certain limitations. Beneficiaries who’ve paid for laboratory developed tests since Jan. 1, 2013, that are now included in the demonstration are eligible for retroactive reimbursement. Additional details about retroactive payments will be forthcoming. TRICARE is currently developing the policy to implement the demonstration.

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