Understanding Tricare Coverage for Weight Loss Drugs
Tricare is a health insurance program for military service members and their families. As with any health insurance program, there are certain restrictions and coverage limitations on certain medications, including weight loss drugs. So, are weight loss drugs covered by Tricare? The answer is not a simple yes or no.
Tricare coverage for weight loss drugs depends on a few factors, such as the type of drug, the medical necessity, and the prescribing physician. In general, Tricare covers medications that are FDA-approved for weight loss and prescribed for medical necessity. However, certain weight loss drugs, such as over-the-counter supplements, are not covered by Tricare.
FDA-Approved Weight Loss Drugs
Tricare coverage for weight loss drugs includes FDA-approved medications that are prescribed for individuals with a BMI of 30 or higher, or a BMI of 27 or higher with at least one weight-related medical condition. Examples of FDA-approved weight loss drugs include:
- Phentermine
- Orlistat
- Lorcaserin
- Naltrexone-bupropion
If your doctor prescribes one of these medications for medical necessity, Tricare will cover the cost. However, it’s important to note that Tricare has certain limitations on the amount of medication allowed per prescription and per month.
Non-FDA Approved Weight Loss Drugs
Tricare does not cover non-FDA approved weight loss drugs, including over-the-counter supplements and herbal remedies. These types of weight loss products are not regulated by the FDA and may not be safe or effective for weight loss.
If you’re considering taking a non-FDA approved weight loss drug, it’s important to discuss it with your doctor and weigh the potential risks and benefits. Your doctor may be able to recommend a safe and effective FDA-approved medication for your weight loss goals.
Medical Necessity
Tricare coverage for weight loss drugs requires medical necessity. This means that your doctor must provide documentation that the medication is necessary for your health and well-being. If you’re taking a weight loss drug for cosmetic reasons, it will not be covered by Tricare.
Prescribing Physician
Tricare coverage for weight loss drugs also depends on the prescribing physician. The drug must be prescribed by a licensed physician, nurse practitioner or physician assistant. Additionally, the prescribing physician must be enrolled in Tricare and must follow Tricare guidelines for prescribing medications.
Alternatives to Weight Loss Drugs
If weight loss drugs are not covered by Tricare, or if you prefer not to take medication for weight loss, there are alternative options. These include:
Nutrition and Exercise
Nutrition and exercise are essential components of a healthy weight loss plan. Eating a balanced diet and engaging in regular physical activity can help you lose weight and improve your overall health. Your doctor or a registered dietician can help you develop a nutrition and exercise plan that works for you.
Behavioral Therapy
Behavioral therapy can help you identify and change unhealthy eating habits and behaviors. This can include counseling or support groups to help you make lifestyle changes and develop healthy habits.
Bariatric Surgery
Bariatric surgery may be an option for individuals with a BMI of 40 or higher, or a BMI of 35 or higher with at least one weight-related medical condition. Tricare does cover bariatric surgery for eligible individuals. However, it’s important to discuss the risks and benefits of surgery with your doctor before making a decision.
Conclusion
So, are weight loss drugs covered by Tricare? The answer is yes and no. Tricare covers FDA-approved weight loss drugs prescribed for medical necessity by an enrolled physician. However, non-FDA approved weight loss drugs and those prescribed for cosmetic reasons are not covered. If weight loss drugs are not covered by Tricare, there are alternative options, such as nutrition and exercise, behavioral therapy, and bariatric surgery. It’s important to discuss all options with your doctor and make an informed decision about your weight loss goals.