COVID-19 Update: Vaccines, Testing and Treatment
Wednesday, February 23, 2022
As we approach the end of year two of the COVID-19 pandemic, please take a moment to review the latest on COVID-19 vaccines, testing and treatment for your TRICARE patients. TRICARE continues to follow Centers for Disease Control and Prevention (CDC) guidelines. In this ever-changing environment, be sure to visit www.cdc.gov/coronavirus, www.tricare-west.com/go/COVID19 and www.tricare.mil/coronavirus for the latest updates.
For vaccines:
- TRICARE covers age-appropriate COVID-19 vaccines at no cost and without prior authorization requirements.
- Pfizer-BioNTech and Moderna have received full FDA approval and are preferred over the Johnson & Johnson Janssen vaccine.
- For those who are immunocompromised, a fourth vaccine (three primary doses of Pfizer or Moderna, one booster of any approved vaccine) is now within guidelines. Note: If the patient received the first dose from a non-civilian provider, please provide a copy of their vaccine card or claim note indicating date of the first dose.
- Find complete details on vaccines, including boosters, dosage, eligible age groups, and recommendations at www.cdc.gov/coronavirus/2019-ncov/vaccines/different-vaccines.html.
For testing:
- TRICARE covers medically necessary COVID-19 tests ordered by a TRICARE-authorized provider and performed at a TRICARE-authorized lab or facility.
- FDA-approved at-home antigen rapid diagnostic test kits may be covered with a physician's order. There are no copayments or cost-shares for covered tests.
- Outside of the TRICARE benefit, patients have access to free at-home test kits from COVIDtest.gov. Beneficiaries can also check with local military hospitals and clinics for free test kit availability. Those with other health insurance (OHI) may be able to get reimbursed for up to eight tests/month through their OHI plan. (The mandate for insurance companies to cover COVID tests without a doctor’s order does not apply to TRICARE.)
For treatment:
- Paxlovid and Molnupiravir oral anti-viral treatments may be prescribed to those who have tested positive. The FDA recommends Paxlovid as a first line treatment; Molnupiravir is used as a last resort due to relatively lower efficacy and some exclusions for use in pregnancy. Beneficiaries can fill prescriptions for these treatments at network, non-network or military pharmacies, subject to availability.
- As of Jan. 24, 2022, Emergency Use Authorizations (EUAs) remain in place for two COVID-19 monoclonal antibody treatments (one inpatient, one outpatient). Visit www.phe.gov for details. Patients must be ages 12 or older, considered at high risk, and have a positive COVID-19 test or exposure. TRICARE requires prior authorization for infusions administered in a home setting and TRICARE Prime referral rules apply.
