Diabetes Coverage on TRICARE: Meds, Pumps & Costs | TRICARE.com

Yes, TRICARE covers the diagnosis and treatment of both Type 1 and Type 2 diabetes, including insulin, oral medications, and supplies. Coverage includes medical oversight by specialists (endocrinologists) and specific equipment like continuous glucose monitors (CGMs) and insulin pumps when medical necessity criteria are met.

*Note: TRICARE.com is an independent reference site and is not affiliated with the Department of Defense or the official TRICARE program. For official policy, visit TRICARE.mil.*

## What TRICARE covers TRICARE provides comprehensive coverage for diabetes management, provided the services are prescribed by a TRICARE-authorized provider.

* **Insulin & Medications:** Coverage for various forms of insulin and oral glucose-lowering drugs through the TRICARE Pharmacy Program (managed by Express Scripts). * **Equipment & Supplies:** * **Continuous Glucose Monitoring (CGM) Systems:** Covered for Type 1 and Type 2 patients who meet specific criteria (e.g., requires multiple daily injections of insulin or an insulin pump). * **Insulin Pumps:** Covered as Durable Medical Equipment (DME). * **Standard Supplies:** Blood glucose strips, lancets, monitors, and syringes. * **Medical Services:** * **Endocrinology Visits:** Specialist consultations for disease management. * **Diabetes Self-Management Training (DSMT):** Outpatient education to help patients manage their condition. * **Eye Exams:** Annual diabetic retinopathy screenings are covered (more frequent than standard vision benefits). * **Foot Care:** Routine foot care is generally excluded, but TRICARE covers therapeutic shoes and inserts for beneficiaries with severe diabetic foot disease. * **Exclusions:** TRICARE typically does not cover over-the-counter (OTC) items like alcohol swabs or skin prep wipes unless they are part of a larger covered supply kit.

## Costs Costs for diabetes care vary based on your plan and beneficiary category (Group A vs. Group B). Below are estimated 2026 rates for common services:

| Service Type | TRICARE Prime | TRICARE Select | TRICARE For Life | | :--- | :--- | :--- | :--- | | **Primary Care Visit** | $0 (Active Duty) / ~$25 (Retirees) | ~$35 - $60 | $0 (after Medicare pays) | | **Specialist (Endo)** | $0 (Active Duty) / ~$40 (Retirees) | ~$55 - $80 | $0 (after Medicare pays) | | **Insulin (Brand Name)** | $38 (Home Delivery/90 days) | $38 (Home Delivery) | $38 (Home Delivery) | | **CGM Supplies** | Covered as DME (0% - 20%) | 20% - 25% of cost | 20% of Medicare amount |

*Note: Pharmacy copayments are standardized across all plans. Generic medications at home delivery are typically $13 for a 90-day supply (2026 rates).*

## Pre-authorization & referrals * **TRICARE Prime:** Active Duty Service Members (ADSMs) and Prime enrollees require a referral from their Primary Care Manager (PCM) to see an endocrinologist. Pre-authorization is usually required for high-tech DME like insulin pumps and CGMs. * **TRICARE Select:** No referrals are required to see a specialist, but you must ensure the provider is TRICARE-authorized. Prior authorization is still required for certain medical equipment (insulin pumps). * **TRICARE For Life:** Use Medicare-certified providers. Medicare acts as the primary payer; if Medicare covers the service/equipment, TRICARE typically pays the remaining balance without a separate authorization.

## Where to get care To receive the highest level of coverage and lowest out-of-pocket costs, you should use network providers managed by your regional contractor: * **East Region:** Contact **Humana Military** to find in-network endocrinologists and diabetes educators. * **West Region:** Contact **TriWest Healthcare Alliance** (the current contractor as of 2025) to find providers in the western U.S. * **Pharmacy:** Most diabetes supplies and medications should be handled through **Express Scripts** via Home Delivery for the lowest cost, or at a military pharmacy for $0.

## Sources * [TRICARE.mil: Diabetes Management and Supplies](https://www.tricare.mil/CoveredServices/IsItCovered/Diabetes) * [TRICARE Policy Manual 6010.63-M: Endocrine System (Chapter 7)](https://manuals.health.mil/) * [TRICARE Pharmacy Program: Express Scripts](https://www.tricare.mil/pharmacy) * [Defense Health Agency: Durable Medical Equipment Policy](https://health.mil)