Mobile Medical Application Details

Mobile medical applications (MMA) – also called mHealth apps, software-as-a-medical devices, and digital therapeutics – are accessed through smart watches, tablets, smartphones, and other mobile platforms. 

TRICARE will only cover MMAs that meet the durable medical equipment (DME) definition defined in TRICARE Policy Manual (TPM), Chapter 8, Section 2.1. Currently, no MMAs meet these TRICARE requirements.

To be eligible for coverage MMAs must:

• Have been determined safe and effective by the Defense Health Agency (DHA).
• Be condition-specific, meaning they treat a specific health condition rather than support an individual’s overall health and wellness.
• Be medical in nature
• Be medically or psychologically necessary
• Be prescribed by a TRICARE-authorized provider who is acting within the scope of their license. Prescriptions will be required annually for subscription-based MMAs. Prescriptions for subscriptions will require medical necessity evaluations after the first three months and annually thereafter.
• Have been approved or cleared by the FDA.
• Comply with Health Insurance Portability and Accountability Act (HIPAA) requirements.

If at any point an MMA meets these requirements, DHA will add the MMA to TPM, Chapter 8, Section 2.1, Paragraph 3.12.2. 

Patients use sensors to take and upload biometric readings to a platform for use with an MMA. Sensors may include blood pressure monitors, thermometers, electrocardiograms, and blood glucometers, as well as non-medical equipment such as fitness trackers. 

Connected medical devices are used with MMAs but do not, themselves, monitor the patient. 

To be covered under TRICARE, sensors and connected medical devices must meet the requirements defined in TPM, Chapter 8, Section 2.1. 

For sensors and connected medical devices that require an MMA to function (that is, the sensor/medical device and MMA function as one unit), then both the equipment and the MMA will need to be eligible for coverage to receive reimbursement.

TRICARE does not cover platforms that do not meet DME guidelines, such as smartphones, tablets, computers, and smartwatches.