Defense health officials have added six preconception and prenatal genetic tests to military members’ health care benefits.
The lab tests that are now a Tricare covered medical benefit include one test per condition, per lifetime, for these genetic disorders:
- Cystic fibrosis
- Spinal muscular atrophy
- Fragile X syndrome
- Tay-Sachs disease
- Conditions linked with Ashkenazi Jewish descent
The tests are approved retroactively back to Dec. 27, 2021, when a law went into effect specifying they would become part of Tricare’s basic coverage. So, beneficiaries who have paid out of pocket for one of these screenings since that date can apply for reimbursement by contacting their Tricare regional contractor. Beneficiaries can also request that Tricare reprocess a claim that had been denied for a test during that time. The new policy took effect July 19.
“Preconception and prenatal carrier screenings help identify people at risk for having children with genetic conditions that may have a high level of death or a shortened life expectancy,” said LaChanda Black, a Tricare management and program analyst, in a statement accompanying the Defense Health Agency announcement. “Providing families access to these screenings can help them make decisions when planning their family.”
These six tests were previously part of the Laboratory Developed Tests Demonstration Project, but have been moved to become part of the Tricare benefit.
The demonstration project includes many other tests, however, and has been extended for another five years, through July 18, 2028. The program gives Tricare beneficiaries access to certain tests that aren’t yet approved by the Food and Drug Administration.
According to a July 13 notice in the Federal Register, Defense Health Agency officials cite “an ever-expanding pool of non-FDA-approved LDTs, including tests for cancer risk, diagnosis and treatment; blood and clotting disorders; a variety of genetic diseases and syndromes; and neurological conditions.”
Officials note that in some instances, “LDTs are important and necessary tests and, in many instances, there are no FDA-approved/cleared alternatives.”
The agency started the demonstration project in 2014 to review non-FDA-approved laboratory developed tests to determine if they meet Tricare’s requirements for safety and effectiveness, and otherwise meet Tricar’s criteria for coverage. During the demonstration, DHA allows tests that meet such criteria to be covered as a benefit.
The project has been extended several times.
The non-FDA-approved tests covered under the demonstration are available under cost-sharing for eligible Tricare beneficiaries, but they must be performed by a laboratory that is assessed and certified or accredited under minimum quality standards set by the Centers for Medicare and Medicaid Services.
Beneficiaries should check with their provider or regional contractor to find out what tests are included in the demonstration.
The cost to extend the demonstration project for another five years is expected to total about $199 million, according to the Federal Register notice.