Tricare to expand test coverage

Tricare announced that it will expand coverage of laboratory-developed tests (LDTs) under a new demonstration program.

The new Defense Health Agency demonstration project will allow Tricare to review LDTs that have not been examined by the Food and Drug Administration, and to determine if they are safe and effective for use.

While Tricare generally covers only LDTs reviewed and approved by the Food and Drug Administration, the new demonstration project will allow Tricare to perform its own evaluations of the diagnostic tests, and set up a process to create and maintain a list of LDTs that have been reviewed and approved for coverage.

The regional Tricare contractor must pre-approve use of a test for it to be covered, Tricare said. Beneficiaries who already have paid for laboratory-developed tests since Jan. 1, 2013, that are included in the demonstration will be eligible for retroactive reimbursement.

According to Tricare, the project includes coverage for prenatal and preconception cystic fibrosis carrier screening, with certain limitations. In a Federal Register notice describing the program, Tricare noted that carrier screening for CF has been widely recognized and commonly provided as part of routine obstetric care.

Tricare said it currently is developing policies to implement the demonstration program.

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