DoD Extends Healthcare Testing Pilot Program, Adds New Diagnostic Tests
UPDATE 8/29/2023: TRICARE now covers several preconception and prenatal carrier screenings including some mentioned below. These are tests previously offered through the Laboratory Developed Test (LDT) demonstration program. These screenings are now part of the basic TRICARE benefit.
In 2013, the Defense Health Agency introduced a pilot program to allow the DoD to provide military members and their families with certain healthcare testing that fell outside FDA regulatory procedures.
That testing includes certain screenings for breast cancer risk, tests for cystic fibrosis, and genetic testing for rare conditions. These tests are typically not covered under TRICARE because they are deemed “not medically necessary” regardless of their usefulness.
Now, that pilot program has been expanded in terms of how long it may operate and the kinds of testing and other medical options available through the program.
What is a Laboratory Developed Test or LDT?
The pilot program covers something called Laboratory-Developed Tests. These tests are, according to Congressional Research Service, “a class of in vitro diagnostic (IVD) device that is designed, manufactured, and used within a single laboratory.”
LDTs are often used to test for conditions or diseases that are “either rapidly changing” such as new strains of infectious diseases. They are also used in research such as genome testing for cancer.
Related: TRICARE Basics
Pilot Program For Laboratory-Developed Tests (LDTs)
The DoD announced the pilot program in 2014, following a statement by TRICARE that it could no longer cover LDTs due to changes to procedure coding by the American Medical Association that put these tests on what some refer to as a “no pay” list for the federal government.
The DoD responded to that move, which resulted in millions of dollars in unpaid medical bills, by creating the pilot program. Why did the DoD do this instead of simply asking TRICARE to reconsider its position?
TRICARE is bound by federal laws, including those that prevent coverage for certain medications or medical devices labeled as not “medically necessary” or those not formally approved by the FDA. DoD created the pilot program to ensure continuing care.
Expanded Pilot Program
The Pentagon announced an extension of this pilot program through July 18, 2028.
There are also updates to the types of testing it will cover; now, some 45 options are available. The tests that have been added to the program include but may not be limited to:
- Biotheranostics Breast Cancer Index
- DermTech Pigmented Lesion Assay
- FoundationOne Heme Test
- Prostate cancer testing by MDxHealth
TRICARE patients who have received a new test in the updated program since Jan. 1, 2023, may be eligible to use TRICARE to pay for it. You must file a claim to receive a TRICARE claim for one of these tests.
To be compensated, the testing must be pre-approved by TRICARE, and an authorized TRICARE provider must administer the test
Related: Ultimate TRICARE Guide
About the author
Editor-in-Chief Joe Wallace is a 13-year veteran of the United States Air Force and a former reporter/editor for Air Force Television News and the Pentagon Channel. His freelance work includes contract work for Motorola, VALoans.com, and Credit Karma. He is co-founder of Dim Art House in Springfield, Illinois, and spends his non-writing time as an abstract painter, independent publisher, and occasional filmmaker.