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Contributor
liz71
Total Posts: 102
Registered on: ‎11-01-2009

Active duty & Tricare

My husband is type 2 and is now taking insulin. We are wondering if there are any others out there that are active duty and on insulin plus tricare. If so have any of you wanted to try to get a insulin pump and tricare would or wouldn't cover it?


Thanks Liz
Diabetes living with me I'm not living with it! Diabetic for 37 years. Using MM Revel & cgms & loving it.
Advisor
hondrigata1
Total Posts: 544
Registered on: ‎11-02-2009

Active duty & Tricare

If you live near a military base call the military pharmacy and ask what they have. Or, if you are using a civilian pharmacy, they will submit the prescription and see what is covered. If you are covered by private health insurance and tricare as secondary, my experience is that tricare will pick up any co pay over $10.00.
Clean eating low carb diet and exercise, cardio/weight training plus Tennis, Body Combat and Zumba 6 days a week. 500mg Metformin;2X; A1C 6.8 of 3/1/2014
Established Contributor
arrivedt2
Total Posts: 1,350
Registered on: ‎10-31-2009

Active duty & Tricare

Liz, Tricare standard or tricare prime? Standard it is not much cost for Tricare because standard has you picking up most of the costs, Prime has only the deduction amount with tricare picking up the bulk of costs!! But with either standard or prime coverage have the treating PCP submit ALL information to Tricare as to WHY PUMP IS required over injections, yes it's still injections over pumps (pumps cost tricare more). PCP needs to SPELL ALL reasons why pump is really required over injections and back that request with DATA showing why.

Promise me you'll always remember:
"You're Braver than you believe, Stronger that you seem, and Smarter than you think !"

Christopher Robin to Pooh Bear

Lee, T2 since 07/1988
Live long and prosper.

"Don't waste any tomorrows because of what you didn't do yesterday !"

Frequent Advisor
mbkjad
Total Posts: 181
Registered on: ‎11-05-2009

Active duty & Tricare

Liz,

Need a little clarification. First.....my background. Active duty naval officer who was diagnosed type 2 in March of 2008 (I might be off just a bit on that). I personally have known several other active duty service members (enlisted and officer) during the last 20 years.

The really important question is which of you is the service member. My read of your statement is that your husband (the one diagnosed with the big D is). If that is the case he needs to get educated real quick. The general rule is that active duty service members can stay on active duty only as long as they do not require a needle and their diabetes is in relative control. Each service has their own twist on it. Army requires med board even if only oral meds are prescribed. Navy won't med board you unless you need something requiring a needle. If he is near retirement then the med board will usually let him stick around long enough to be retirement eligible. For the Navy, there is an exception that if your rate/designator is not conducive to a diagnosis of D then sometimes that can be the end as well whether on insulin/needles as well.

If he is the dependent then the Tricare Prime vs Extra vs. standard question would be next. Ultimately the best deal in this scenario would be to get any prescriptions filled via the Express Scripts process (though I am not a huge fan of it). This approach gets you a 90 day supply for the same co-pay you pay for a 30 day supply everywhere else (assuming you can't get it filled at a military pharmacy which has no co-pay).

There are several retirees on the boards who know a lot on the TRICARE for Life program. I haven't seen too many around who are active duty with the D though we are out there.

Bottom Line....If he is the member he needs to figure out his rights and regulations quickly. The med board process has points where he gets input (as well as command endorsements). NOTE: Please don't get your hopes up too much if he is the member....waivers in this area were rare in the '90's, since 2001 they are non-existent....Primary reason for this is CENTCOM blanket policy barring diabetics from service within their AOR. If he is the dependent then get with the TRICARE reps for benefits question. One dumb policy is that TRICARE doesn't pay for education services so the only way I know to get to a CDE is through a referral to an endo where if the endo has on in his/her office you can get them to pay for 2 sessions.

There is so much more but mind is starting to ramble. Will check the thread periodically though I may be somewhat delayed as my son is arriving tomorrow for two weeks home prior to deploying.

Mike
Mike

Diagnosed Type 2 March 2008 (give or take a few months)
A1c: 6.4 (May 2013), 6.2 (Feb 2013), 5.9 (Nov 2012), 5.7 (Aug 2012) 6.5 (31 Jan 2012)
Meds:
Metformin XR 2000 mg daily
Lovaza 2 grams daily
Lipitor 10 mg daily
Fenofibrate 165 mg daily
Lisinopril 2.5 mg daily
Novolog
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Multivitamin
Began Pumping in June 2013
Contributor
liz71
Total Posts: 102
Registered on: ‎11-01-2009

Active duty & Tricare

arrivedt2 (4/21/2010)
Liz, Tricare standard or tricare prime? Standard it is not much cost for Tricare because standard has you picking up most of the costs, Prime has only the deduction amount with tricare picking up the bulk of costs!! But with either standard or prime coverage have the treating PCP submit ALL information to Tricare as to WHY PUMP IS required over injections, yes it's still injections over pumps (pumps cost tricare more). PCP needs to SPELL ALL reasons why pump is really required over injections and back that request with DATA showing why.



We are on prime. We know that tricare will cover the pump and supplies at 100% as long as we stay active duty. We have heard that tricare does not cover pumps for type 2s so we are trying to find out if this is true or false.
If you know of any facts or other things please let me know. I'm the one that starts yelling at tricare to get what I want they don't like me too much

But thank you for your help!



Liz
Diabetes living with me I'm not living with it! Diabetic for 37 years. Using MM Revel & cgms & loving it.
Established Contributor
arrivedt2
Total Posts: 1,350
Registered on: ‎10-31-2009

Active duty & Tricare

Liz, As Mike has stated if your T2 and now your husband is also T2 and HE is active duty member then get HIM to be in touch with Tricare and base medical to find out how HIS branch of service handles T2 meds. MOst do allow oral meds to be taken but not in combat zones or for some TOUCHY types (classes) of jobs!! Injections is were most draw the line because they require member to test BG level then make injection up for what is needed, again some branches DON'T allow this T2 to remain on active duty, period, they are usually med boarded out or place at desk work for short period before retirement!

I am a retiree so what Tricare Prime allows for me IS different then any active duty branch approval. Mike, Tricare Prime does cover CDE Classes for retirees I had four classes an only paid 12.00 co-pay like office visit Tricare Prime covered rest of the costs!!

Sounds like your dependent with T2 Liz, and service member your husband just got T2 Dx, and he is currently on active duty so please do ask I stated above with his service branch to handle his T2. Dependants active or retired members usually can have Tricare cover more of meds/injections/pumps costs and use than an Active Duty member is allowed to use.

Promise me you'll always remember:
"You're Braver than you believe, Stronger that you seem, and Smarter than you think !"

Christopher Robin to Pooh Bear

Lee, T2 since 07/1988
Live long and prosper.

"Don't waste any tomorrows because of what you didn't do yesterday !"

Contributor
liz71
Total Posts: 102
Registered on: ‎11-01-2009

Active duty & Tricare

mbkjad@yahoo.com (4/22/2010)
Liz,



Need a little clarification. First.....my background. Active duty naval officer who was diagnosed type 2 in March of 2008 (I might be off just a bit on that). I personally have known several other active duty service members (enlisted and officer) during the last 20 years.



The really important question is which of you is the service member. My read of your statement is that your husband (the one diagnosed with the big D is). If that is the case he needs to get educated real quick. The general rule is that active duty service members can stay on active duty only as long as they do not require a needle and their diabetes is in relative control. Each service has their own twist on it. Army requires med board even if only oral meds are prescribed. Navy won't med board you unless you need something requiring a needle. If he is near retirement then the med board will usually let him stick around long enough to be retirement eligible. For the Navy, there is an exception that if your rate/designator is not conducive to a diagnosis of D then sometimes that can be the end as well whether on insulin/needles as well.



If he is the dependent then the Tricare Prime vs Extra vs. standard question would be next. Ultimately the best deal in this scenario would be to get any prescriptions filled via the Express Scripts process (though I am not a huge fan of it). This approach gets you a 90 day supply for the same co-pay you pay for a 30 day supply everywhere else (assuming you can't get it filled at a military pharmacy which has no co-pay).



There are several retirees on the boards who know a lot on the TRICARE for Life program. I haven't seen too many around who are active duty with the D though we are out there.



Bottom Line....If he is the member he needs to figure out his rights and regulations quickly. The med board process has points where he gets input (as well as command endorsements). NOTE: Please don't get your hopes up too much if he is the member....waivers in this area were rare in the '90's, since 2001 they are non-existent....Primary reason for this is CENTCOM blanket policy barring diabetics from service within their AOR. If he is the dependent then get with the TRICARE reps for benefits question. One dumb policy is that TRICARE doesn't pay for education services so the only way I know to get to a CDE is through a referral to an endo where if the endo has on in his/her office you can get them to pay for 2 sessions.



There is so much more but mind is starting to ramble. Will check the thread periodically though I may be somewhat delayed as my son is arriving tomorrow for two weeks home prior to deploying.



Mike


Hi Mike my husband is a Gunny in USMC and he was diagnosed 4 1/2 years ago as a type 2. He has I guess you could say fought with tricare about certain meds and so on before and the out come has been the same "Sorry it's not in our formulary so you don't get that" and on the flip side of that me being the dependant I can get whatever I need because I have a pump.
USMC is not med boarding him he just hit his 20 years so they are going to wave the med board and let him retire just as soon as we get other medical issues figured out.

Don't worry about trying to reply back to me PLEASE SPEND TIME WITH YOUR SON!!! He is way more important!!!


Thanks again Liz
Diabetes living with me I'm not living with it! Diabetic for 37 years. Using MM Revel & cgms & loving it.
Contributor
liz71
Total Posts: 102
Registered on: ‎11-01-2009

Active duty & Tricare

arrivedt2 (4/23/2010)
Liz, As Mike has stated if your T2 and now your husband is also T2 and HE is active duty member then get HIM to be in touch with Tricare and base medical to find out how HIS branch of service handles T2 meds. MOst do allow oral meds to be taken but not in combat zones or for some TOUCHY types (classes) of jobs!! Injections is were most draw the line because they require member to test BG level then make injection up for what is needed, again some branches DON'T allow this T2 to remain on active duty, period, they are usually med boarded out or place at desk work for short period before retirement!



I am a retiree so what Tricare Prime allows for me IS different then any active duty branch approval. Mike, Tricare Prime does cover CDE Classes for retirees I had four classes an only paid 12.00 co-pay like office visit Tricare Prime covered rest of the costs!!



Sounds like your dependent with T2 Liz, and service member your husband just got T2 Dx, and he is currently on active duty so please do ask I stated above with his service branch to handle his T2. Dependants active or retired members usually can have Tricare cover more of meds/injections/pumps costs and use than an Active Duty member is allowed to use.



Thanks again Lee!

I'm type1 have been for 36 years Yes I'm a dependant and also been with USMC most of my life I still remember it being champus. And yes tricare does cover CDE's and they also cover durable medical equipment but only under certain things

Well I've heard from Minimed this morning and they are submitting the paper work for a pump for him and an upgrade to mine so now all we need to do is cross our fingers and hope it goes through.

I will let you know later on

Thanks Again Liz
Diabetes living with me I'm not living with it! Diabetic for 37 years. Using MM Revel & cgms & loving it.