TRICARE does cover both tirzepatide and semaglutide, but there are specific requirements:
Tirzepatide (Mounjaro):
* For Type 2 Diabetes: TRICARE will cover Mounjaro when it's prescribed for T2D. You'll have to meet certain requirements and have a valid prescription. Your doctor will need to fill out prior authorization forms and demonstrate medical necessity. Other medications, such as a different brand, might be available at a lower cost.
* For Weight Loss: Mounjaro is not currently FDA-approved for weight management, so TRICARE won't cover it if it's prescribed solely for weight loss.
Semaglutide:
* As a brand name for Type 2 Diabetes: TRICARE covers this medication, which contains semaglutide, for treating T2D. Just like with Mounjaro, you'll need to meet specific criteria, have a prescription from a licensed healthcare provider, and have your doctor complete the necessary prior authorization and medical necessity forms.
* As a brand name for Weight Management: TRICARE covers Wegovy for weight management in certain cases. To be eligible, you need a BMI of 30 or higher, OR a BMI of 27 or higher with risk factors like high blood pressure or sleep apnea. Also, you need to have tried lifestyle changes and dietary restrictions for at least six months without success, AND have tried and failed (or have contraindications for) at least one other prescription weight loss medication. Ongoing lifestyle changes and a reduced-calorie diet are also required throughout treatment. Your doctor also needs to complete prior authorization forms.
To figure out your exact eligibility and potential costs, talk to your doctor and check the TRICARE Formulary Search Tool.
I got this info from a chatbot. It looks like those medical necessity forms are key with Tricare.
