TRICARE: Notice of TRICARE Plan Program Changes for Calendar Year 2025, 88742-88744 [2024-26066]
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88742
Federal Register / Vol. 89, No. 217 / Friday, November 8, 2024 / Notices
DEPARTMENT OF DEFENSE
Office of the Secretary
[Docket ID: DoD–2024–OS–0015]
Submission for OMB Review;
Comment Request
Office of the Under Secretary of
Defense for Personnel and Readiness
(OUSD(P&R)), Department of Defense
(DoD).
ACTION: 30-Day information collection
notice.
AGENCY:
The DoD has submitted to the
Office of Management and Budget
(OMB) for clearance the following
proposal for collection of information
under the provisions of the Paperwork
Reduction Act.
DATES: Consideration will be given to all
comments received by December 9,
2024.
SUMMARY:
Written comments and
recommendations for the proposed
information collection should be sent
within 30 days of publication of this
notice to www.reginfo.gov/public/do/
PRAMain. Find this particular
information collection by selecting
‘‘Currently under 30-day Review—Open
for Public Comments’’ or by using the
search function.
FOR FURTHER INFORMATION CONTACT:
Reginald Lucas, (571) 372–7574,
whs.mc-alex.esd.mbx.dd-dodinformation-collections@mail.mil.
SUPPLEMENTARY INFORMATION:
Title; Associated Form; and OMB
Number: Application for Surrogate
Association for DoD Self-Service (DS)
Logon; DD Form 3005; OMB Control
Number 0704–0559.
Type of Request: Revision.
Number of Respondents: 2,500.
Responses per Respondent: 1.
Annual Responses: 2,500.
Average Burden per Response: 8
minutes.
Annual Burden Hours: 333.
Needs and Uses: This information
collection is needed to obtain the
necessary data to establish an
individual’s eligibility for Defense
Enrollment Eligibility Reporting System
(DEERS) and DS Logon credential
issuance as a surrogate. Information is
collected via the DD Form 3005,
‘‘Application for Surrogate Association
for DS Logon,’’ and used to establish a
record in DEERS and issue a DS Logon
credential in accordance with DoDM
1341.02, Volume 1. The information
that is collected may be released to
Federal and State agencies and private
entities, on matters relating to
utilization review, professional quality
ddrumheller on DSK120RN23PROD with NOTICES1
ADDRESSES:
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assurance, program integrity, civil and
criminal litigation, and access to Federal
government facilities, computer
systems, networks, and controlled areas.
Affected Public: Individuals or
households.
Frequency: On occasion.
Respondent’s Obligation: Voluntary.
OMB Desk Officer: Ms. Jasmeet
Seehra.
DOD Clearance Officer: Mr. Reginald
Lucas.
Dated: November 4, 2024.
Stephanie J. Bost,
Alternate OSD Federal Register Liaison
Officer, Department of Defense.
[FR Doc. 2024–25955 Filed 11–7–24; 8:45 am]
BILLING CODE 6001–FR–P
DEPARTMENT OF DEFENSE
Office of the Secretary
TRICARE: Notice of TRICARE Plan
Program Changes for Calendar Year
2025
Office of the Secretary of
Defense, Department of Defense (DoD).
ACTION: Notice; TRICARE Plan Program
Changes for Calendar Year 2025.
AGENCY:
This notice provides
information regarding TRICARE Plan
Program Changes for Calendar Year (CY)
2025.
DATES: TRICARE Health Plan
information in this notice is valid for
services during CY 2025 (January 1,
2025–December 31, 2025).
ADDRESSES: Defense Health Agency,
TRICARE Health Plan Division, 7700
Arlington Boulevard, Suite 5101, Falls
Church, Virginia 22042–5101.
FOR FURTHER INFORMATION CONTACT: Ms.
Debra Fisher, phone: (703) 275–6224.
SUPPLEMENTARY INFORMATION: A final
rule published in the Federal Register
(FR) on February 15, 2019, (84 FR 4326–
4333) established the requirement for
the Director, Defense Health Agency
(DHA), to provide public notice to
Military Health System (MHS)
beneficiaries each calendar year in
connection with the annual open season
enrollment period with a summary of
changes to the TRICARE program. The
following changes or improvements to
the TRICARE program benefits apply for
CY 2025.
SUMMARY:
Announcement of Open Season
Open Season is an annual period
when beneficiaries can enroll in or
make changes to their healthcare,
dental, and vision coverage for the next
calendar year.
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During the TRICARE Open Season
that runs from November 11, 2024,
through December 10, 2024, qualified
MHS beneficiaries may enroll in or
change their TRICARE Prime or
TRICARE Select plan.
During the Federal Employee Dental
and Vision Insurance Program (FEDVIP)
Open Season that runs from November
11, 2024, through December 9, 2024,
qualified MHS beneficiaries, including
TRICARE for Life beneficiaries, may
enroll in or make changes to their dental
and vision plans. FEDVIP is operated by
the U.S. Office of Personnel
Management.
Any changes MHS beneficiaries make
during Open Season will take effect on
January 1, 2025. If a beneficiary remains
eligible and does not make any changes
during Open Season, then their coverage
will stay the same for 2025. TRICARE
enrollees can ensure they receive
important health plan information by
promptly listing any change in address
and other information in the Defense
Enrollment Eligibility Reporting System
(DEERS). See the Qualifying Life Events
(https://health.mil/Military-HealthTopics/MHS-Toolkits/Toolkits/
QLEhttps://health.mil/Military-HealthTopics/MHS-Toolkits/Toolkits/QLE)
guide for when to update information in
DEERS throughout the year.
Annual Announcements
The following TRICARE program
features are subject to a year-to-year
determination and are announced each
year prior to the annual TRICARE Open
Season.
Urgent Care Visits: There continues to
be no limit on the number of urgent care
visits covered beneficiaries enrolled in
TRICARE Prime can receive without a
referral for Plan Year 2025. Beneficiaries
may receive urgent care from TRICAREauthorized urgent care centers (UCC)
and convenience clinics (CC), either
network or non-network, without a
referral. They may also receive urgent
care from any TRICARE network
provider (i.e., family medicine; internal
medicine-general practice;
pediatricians). In situations when a
TRICARE Prime enrollee seeks care
from a non-network TRICARE
authorized provider (outside of a
TRICARE-authorized UCC or CC), the
usual TRICARE Prime Point of Service
(POS) deductible and cost-shares shall
apply. Private Sector care for active duty
Service members is subject to different
rules. Covered beneficiaries who want
assistance on decisions to seek urgent
care in the United States (U.S.), except
those enrolled in the Uniformed
Services Family Health Plan (USFHP),
may call the MHS Nurse Advice Line
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Federal Register / Vol. 89, No. 217 / Friday, November 8, 2024 / Notices
(NAL) at 1–800–874–2273 for health
care guidance from a specially trained
registered nurse. The NAL is available
24/7 to all non-USFHP TRICARE
beneficiaries. Beneficiaries who live
overseas can call the NAL for health
care advice when traveling in the U.S.
but must coordinate care with their
Overseas Regional Call Center. For
additional information, call the
servicing TRICARE contractor or visit
https://www.tricare.mil/ContactUs and
click on ‘‘MHS Nurse Advice Line.’’
Prime Service Area Changes: Prime
Service Areas (PSAs) are geographic
areas around military medical treatment
facilities and Base Realignment and
Closure sites. PSAs support the medical
readiness of active duty members of the
Uniformed Services by adding to the
capability and capacity of military
hospitals and clinics. There are no
changes to the existing PSAs for
calendar year (CY) 2025.
What’s New
The following changes or
improvements to the TRICARE program
benefits apply to CY 2025 (although
some changes were implemented in
2024):
Managed Care Support Contractors
TRICARE Managed Care Support
Contracts for East and West Regions
Change: Effective January 1, 2025, a set
of new TRICARE Managed Care Support
contracts that facilitate health care in
the private sector will serve
beneficiaries in the East and West
regions. Under the new contracts,
beneficiaries residing in Arkansas,
Illinois, Louisiana, Oklahoma, Texas,
and Wisconsin will shift from the East
to the West region.
ddrumheller on DSK120RN23PROD with NOTICES1
Note: Beneficiaries residing in Arkansas,
Illinois, Louisiana, Oklahoma, Texas, and
Wisconsin, and TRICARE Prime and Select
beneficiaries transitioning from HealthNet
Federal Services to TriWest must contact
their regional contactor if they are paying
enrollment fees or premiums by recurring
credit card and electronic funds transfer
(EFT) to provide their payment information
to ensure there is no break in TRICARE
health care coverage.
Beneficiaries in the West Region will
have a new contractor administering
their TRICARE benefit, TriWest Health
Alliance. Contractor contact information
for West Region beneficiaries receiving
services on or after January 1, 2025, is
provided here: TriWest Healthcare
Alliance, P.O. Box 43470, Phoenix, AZ
85080–3470, Phone: 1–888–TRIWEST
(874–9378); Fax: 1–866–566–9915,
www.tricare.mil/West. Beneficiaries in
the East Region will continue to have
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Jkt 265001
their TRICARE benefits administered by
Humana Government Business.
The TRICARE East and West contracts
include new requirements added to
allow enrolled beneficiaries to call their
regional contractors to get help with
network appointments. This
requirement is intended to assist
beneficiaries currently enrolled to the
network who need support for making
appointments. Beneficiaries who
frequently encounter problems with
network providers not accepting new
patients can contact the regional
contractor for assistance.
Benefit Changes
Coverage of Hearing Aids for Child
Dependents of Former Members of the
Uniformed Services: Hearing aids and
hearing aid services and supplies to
address profound hearing loss may be
covered for child dependents of former
members of the Uniformed Services
who are enrolled in TRICARE Prime,
effective December 22, 2023. Hearing
aid benefits are available to dependents
of a member of the Uniformed Services
on active duty, which includes all
members covered under the Transitional
Assistance Management Program.
Automatic Blood Pressure Monitors:
Automatic blood pressure monitors may
be covered under TRICARE’s Durable
Medical Equipment policy, when
prescribed for a beneficiary who is also
receiving covered Remote Physiologic
Monitoring services, for medically
necessary self-measured blood pressure
monitoring, effective June 29, 2023.
Lipectomy (Liposuction) for
Treatment of Lipedema: Medically
necessary liposuction for the treatment
of lipedema may be covered when
certain coverage criteria are met and
with prior authorization, effective May
28, 2021.
TRICARE Coverage for Over-TheCounter (OTC) Norgestrel: The
TRICARE pharmacy formulary for OTC
drugs covers Norgestrel (Opill) tablet
with a doctor’s prescription. TRICARE
plan copayments or cost-shares may
apply. This addition to the TRICARE
drug formulary does not change OTC
coverage of Levonorgestrel (Plan B OneStep Emergency Contraceptive) for free
without a doctor’s prescription.
Beneficiaries may see the TRICARE drug
formulary search tool for further
information.
Demonstration Changes and Extensions
Childbirth and Breastfeeding Support
Demonstration (CBSD) Childbirth
Support Services Adjustments: The
CBSD will continue into calendar year
2025 and is available to all beneficiaries
except those enrolled in USFHP, the
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88743
Continued Health Care Benefit Program,
and those receiving TRICARE coverage
under TRICARE for Life, with the
following adjustments.
First, starting January 1, 2025, all
Certified Labor Doulas (CLDs)
performing services under the CBSD
must have an agreement to participate
with TRICARE, which means the CLD
must file claims and accept TRICARE
reimbursement as payment in full.
Beneficiaries must select a CLD who has
agreed to participate (in-network or outof-network) to have TRICARE pay for
services. No coverage will be provided
for services received from a CLD
without a TRICARE participation
agreement. Beneficiaries who select a
TRICARE-participating CLD will have
no out-of-pocket expenses (after the
annual deductible has been met).
Second, the allowance for six untimed
visits with a CLD either before or after
delivery are replaced by six hours of
visits, which can be used in 15-minute
increments for visits of different lengths.
Third, TRICARE raised the
reimbursement rates for CLDs. Fourth,
the National Black Doula Association
has been added as an accepted
certifying organization for CLDs.
Finally, TRICARE is waiving the
certification requirement for CLDs with
active Medicaid participation in the
state where practicing. Phase 1 will end
on January 1, 2025, and a new Phase 2
reimbursement for childbirth support
services provided in the 50 United
States and District of Columbia will be
effective from January 1, 2025, through
December 31, 2026. For overseas
locations, the effective date for Phase 2
reimbursement is also January 1, 2025,
through December 31, 2026.
CBSD Overseas: Starting January 1,
2025, beneficiaries enrolled to the
TRICARE Overseas Program (TOP) are
eligible for demonstration services
(doula support and breastfeeding
support by authorized demonstration
providers) when all demonstration
requirements are met. Unlike in the
U.S., TOP beneficiaries must enroll in
the CBSD with the overseas contractor
to be eligible. Beneficiaries can search
provider directories to locate CBSD
providers near them in Germany, Japan,
Italy, South Korea, Puerto Rico, and the
United Kingdom; in other countries, the
overseas contractor will work with the
enrolled beneficiary to find a qualified
provider, if available.
Preventive Service Changes
Pre-Exposure Prophylaxis (PrEP) for,
for the Prevention of HIV Acquisition:
Effective January 1, 2025, HIV preexposure prophylaxis with effective
antiretroviral therapy (i.e., Apretude), as
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Federal Register / Vol. 89, No. 217 / Friday, November 8, 2024 / Notices
well as related office visits, for
adolescents and adults at increased risk
of acquiring HIV, when provided to
TRICARE Prime patients of by network
providers to TRICARE Select patients,
will be considered clinical preventive
services not subject to cost-sharing.
Digital Breast Tomosynthesis for
Breast Cancer Screening as a Clinical
Preventive Services Benefit: DHA will
permanently cover digital breast
tomosynthesis (DBT), also known as 3D
mammography, as a clinical preventive
services benefit not subject to costsharing.
Provisional Coverage Changes
Digital Breast Tomosynthesis for
Breast Cancer Screening as a Clinical
Preventive Services Benefit: Provisional
Coverage of DBT for breast cancer
screening, which spanned from January
1, 2020, to December 31, 2024, will
lapse. However, as noted above, DHA
will continue to cover DBT as a clinical
preventive services benefit not subject
to cost-sharing.
Platelet-Rich Plasma for Major Joint
Treatment and Rehabilitation: Plateletrich plasma (PRP) injections are
excluded from coverage for all
indications. The use of PRP for knee
osteoarthritis and lateral elbow
tendinopathy was covered under
Provisional Coverage status from
October 1, 2019, to September 30, 2024.
Provisional Coverage of PRP lapsed on
September 30, 2024, and will not be
replaced with permanent coverage.
Appendix A
Certain TRICARE enrollee out-ofpocket costs (enrollment fees,
premiums, catastrophic caps,
deductibles, and copayments) are
adjusted annually by federal law and
regulations based on the annual Cost of
Living Adjustment (COLA) applied to
Uniformed Service member retired pay.
A difference in copayments remains
between those who joined a Uniformed
Service before January 1, 2018, (Group
A), and those who joined on or after that
date (Group B).
The retiree COLA is typically
announced after the federal fiscal year
begins in October. Beneficiary out-ofpocket expenses impacted by the 2025
COLA will be posted to the tricare.mil/
changes web page before the start of
TRICARE Open Season, November 11,
2024.
Premium Based Plans
The CY 2025 monthly premiums for
TRICARE Reserve Select, TRICARE
Retired Reserve, and TRICARE Young
Adult and the quarterly premiums for
Continued Health Care Benefit Program
will be posted to the tricare.mil/changes
web page once announced.
Pharmacy Out-of-Pocket Expenses for
CY 2025
TRICARE Pharmacy copayments will
remain unchanged on January 1, 2025:
PHARMACY COPAYMENTS FOR CALENDAR YEAR 2025 *
Year
Retail network
generic
formulary
30-day supply
Retail network
brand-name
formulary
30-day supply
Retail network
non-formulary
30-day supply
Mail order
generic
formulary
90-day supply
Mail order
brand-name
formulary
90-day supply
Mail order
Non-formulary
90-day supply
2025 .....................
$16
$43
$76 **
$13
$38
$76
* Active-duty Service members (ADSM) enjoy a $0 copay for covered drugs at any pharmacy.
** For all beneficiaries except ADSM, select brand-name maintenance medications (taken for long-term conditions) may only be filled twice at
retail and then must be filled through home delivery or military pharmacy.
Dated: November 5, 2024.
Stephanie J. Bost,
Alternate OSD Federal Register Liaison
Officer, Department of Defense.
[FR Doc. 2024–26066 Filed 11–7–24; 8:45 am]
BILLING CODE 6001–FR–P
DEPARTMENT OF DEFENSE
Office of the Secretary
Defense Health Board; Notice of
Federal Advisory Committee Meeting
Under Secretary of Defense for
Personnel and Readiness (USD(P&R)),
Department Defense (DoD).
ACTION: Notice of Federal Advisory
Committee meeting.
AGENCY:
The DoD is publishing this
notice to announce that the following
Federal Advisory Committee meeting of
the Defense Health Board (DHB) will
take place.
DATES: Open to the public Tuesday,
November 19, 2024 from 9 a.m. to 12
p.m. eastern standard time (EST).
ADDRESSES: The address of the open
meeting is 8111 Gatehouse Rd, Room
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SUMMARY:
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17:38 Nov 07, 2024
Jkt 265001
345, Falls Church, VA 22042. The
meeting will be held both in-person and
virtually. To participate in the meeting,
see the Meeting Accessibility section for
instructions.
FOR FURTHER INFORMATION CONTACT:
CAPT Shawn Clausen, 703–275–6060
(voice), shawn.s.clausen.mil@health.mil
(email). Mailing address is 7700
Arlington Boulevard, Suite 5101, Falls
Church, Virginia 22042. Website:
https://www.health.mil/dhb. The most
up-to-date changes to the meeting
agenda can be found on the website.
SUPPLEMENTARY INFORMATION: This
meeting is being held under the
provisions of chapter 10 of title 5,
United States Code (U.S.C.) (commonly
known as the ‘‘Federal Advisory
Committee Act’’ or ‘‘FACA’’), title 5,
U.S.C. 552b (commonly known as the
‘‘Government in the Sunshine Act’’),
and 41, Code of Federal Regulations
(CFR), sections 102–3.140 and 102–
3.150.
Due to circumstances beyond the
control of the DoD, the DHB was unable
to provide public notification required
by 41 CFR 102–3.150(a) concerning its
November 19, 2024 meeting.
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Accordingly, the Advisory Committee
Management Officer, for the Department
of Defense, pursuant to 41 CFR 102–
3.150(b), waives the 15-calendar day
notification requirement.
Availability of Materials for the
Meeting: Additional information,
including the agenda, is available on the
DHB website, https://www.health.mil/
dhb. A copy of the agenda or any
updates to the agenda for the November
19, 2024, meeting will be available on
the DHB website. Any other materials
presented in the meeting may also be
obtained at the meeting. Purpose of the
Meeting: The DHB provides
independent advice and
recommendations to maximize the
safety and quality of, as well as access
to, health care for DoD health care
beneficiaries. The purpose of the
meeting is to provide progress updates
on specific tasks before the DHB.
Agenda: The DHB anticipates
receiving an update on the Ethical
Implementation of Artificial Intelligence
(AI) in the Military Health System
tasking and a briefing on essential
questions and necessary elements of AI
governance.
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Agencies
[Federal Register Volume 89, Number 217 (Friday, November 8, 2024)]
[Notices]
[Pages 88742-88744]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2024-26066]
-----------------------------------------------------------------------
DEPARTMENT OF DEFENSE
Office of the Secretary
TRICARE: Notice of TRICARE Plan Program Changes for Calendar Year
2025
AGENCY: Office of the Secretary of Defense, Department of Defense
(DoD).
ACTION: Notice; TRICARE Plan Program Changes for Calendar Year 2025.
-----------------------------------------------------------------------
SUMMARY: This notice provides information regarding TRICARE Plan
Program Changes for Calendar Year (CY) 2025.
DATES: TRICARE Health Plan information in this notice is valid for
services during CY 2025 (January 1, 2025-December 31, 2025).
ADDRESSES: Defense Health Agency, TRICARE Health Plan Division, 7700
Arlington Boulevard, Suite 5101, Falls Church, Virginia 22042-5101.
FOR FURTHER INFORMATION CONTACT: Ms. Debra Fisher, phone: (703) 275-
6224.
SUPPLEMENTARY INFORMATION: A final rule published in the Federal
Register (FR) on February 15, 2019, (84 FR 4326-4333) established the
requirement for the Director, Defense Health Agency (DHA), to provide
public notice to Military Health System (MHS) beneficiaries each
calendar year in connection with the annual open season enrollment
period with a summary of changes to the TRICARE program. The following
changes or improvements to the TRICARE program benefits apply for CY
2025.
Announcement of Open Season
Open Season is an annual period when beneficiaries can enroll in or
make changes to their healthcare, dental, and vision coverage for the
next calendar year.
During the TRICARE Open Season that runs from November 11, 2024,
through December 10, 2024, qualified MHS beneficiaries may enroll in or
change their TRICARE Prime or TRICARE Select plan.
During the Federal Employee Dental and Vision Insurance Program
(FEDVIP) Open Season that runs from November 11, 2024, through December
9, 2024, qualified MHS beneficiaries, including TRICARE for Life
beneficiaries, may enroll in or make changes to their dental and vision
plans. FEDVIP is operated by the U.S. Office of Personnel Management.
Any changes MHS beneficiaries make during Open Season will take
effect on January 1, 2025. If a beneficiary remains eligible and does
not make any changes during Open Season, then their coverage will stay
the same for 2025. TRICARE enrollees can ensure they receive important
health plan information by promptly listing any change in address and
other information in the Defense Enrollment Eligibility Reporting
System (DEERS). See the Qualifying Life Events (https://health.mil/Military-Health-Topics/MHS-Toolkits/Toolkits/QLEhttps://health.mil/Military-Health-Topics/MHS-Toolkits/Toolkits/QLE) guide for when to
update information in DEERS throughout the year.
Annual Announcements
The following TRICARE program features are subject to a year-to-
year determination and are announced each year prior to the annual
TRICARE Open Season.
Urgent Care Visits: There continues to be no limit on the number of
urgent care visits covered beneficiaries enrolled in TRICARE Prime can
receive without a referral for Plan Year 2025. Beneficiaries may
receive urgent care from TRICARE-authorized urgent care centers (UCC)
and convenience clinics (CC), either network or non-network, without a
referral. They may also receive urgent care from any TRICARE network
provider (i.e., family medicine; internal medicine-general practice;
pediatricians). In situations when a TRICARE Prime enrollee seeks care
from a non-network TRICARE authorized provider (outside of a TRICARE-
authorized UCC or CC), the usual TRICARE Prime Point of Service (POS)
deductible and cost-shares shall apply. Private Sector care for active
duty Service members is subject to different rules. Covered
beneficiaries who want assistance on decisions to seek urgent care in
the United States (U.S.), except those enrolled in the Uniformed
Services Family Health Plan (USFHP), may call the MHS Nurse Advice Line
[[Page 88743]]
(NAL) at 1-800-874-2273 for health care guidance from a specially
trained registered nurse. The NAL is available 24/7 to all non-USFHP
TRICARE beneficiaries. Beneficiaries who live overseas can call the NAL
for health care advice when traveling in the U.S. but must coordinate
care with their Overseas Regional Call Center. For additional
information, call the servicing TRICARE contractor or visit https://www.tricare.mil/ContactUs and click on ``MHS Nurse Advice Line.''
Prime Service Area Changes: Prime Service Areas (PSAs) are
geographic areas around military medical treatment facilities and Base
Realignment and Closure sites. PSAs support the medical readiness of
active duty members of the Uniformed Services by adding to the
capability and capacity of military hospitals and clinics. There are no
changes to the existing PSAs for calendar year (CY) 2025.
What's New
The following changes or improvements to the TRICARE program
benefits apply to CY 2025 (although some changes were implemented in
2024):
Managed Care Support Contractors
TRICARE Managed Care Support Contracts for East and West Regions
Change: Effective January 1, 2025, a set of new TRICARE Managed Care
Support contracts that facilitate health care in the private sector
will serve beneficiaries in the East and West regions. Under the new
contracts, beneficiaries residing in Arkansas, Illinois, Louisiana,
Oklahoma, Texas, and Wisconsin will shift from the East to the West
region.
Note: Beneficiaries residing in Arkansas, Illinois, Louisiana,
Oklahoma, Texas, and Wisconsin, and TRICARE Prime and Select
beneficiaries transitioning from HealthNet Federal Services to
TriWest must contact their regional contactor if they are paying
enrollment fees or premiums by recurring credit card and electronic
funds transfer (EFT) to provide their payment information to ensure
there is no break in TRICARE health care coverage.
Beneficiaries in the West Region will have a new contractor
administering their TRICARE benefit, TriWest Health Alliance.
Contractor contact information for West Region beneficiaries receiving
services on or after January 1, 2025, is provided here: TriWest
Healthcare Alliance, P.O. Box 43470, Phoenix, AZ 85080-3470, Phone: 1-
888-TRIWEST (874-9378); Fax: 1-866-566-9915, www.tricare.mil/West.
Beneficiaries in the East Region will continue to have their TRICARE
benefits administered by Humana Government Business.
The TRICARE East and West contracts include new requirements added
to allow enrolled beneficiaries to call their regional contractors to
get help with network appointments. This requirement is intended to
assist beneficiaries currently enrolled to the network who need support
for making appointments. Beneficiaries who frequently encounter
problems with network providers not accepting new patients can contact
the regional contractor for assistance.
Benefit Changes
Coverage of Hearing Aids for Child Dependents of Former Members of
the Uniformed Services: Hearing aids and hearing aid services and
supplies to address profound hearing loss may be covered for child
dependents of former members of the Uniformed Services who are enrolled
in TRICARE Prime, effective December 22, 2023. Hearing aid benefits are
available to dependents of a member of the Uniformed Services on active
duty, which includes all members covered under the Transitional
Assistance Management Program.
Automatic Blood Pressure Monitors: Automatic blood pressure
monitors may be covered under TRICARE's Durable Medical Equipment
policy, when prescribed for a beneficiary who is also receiving covered
Remote Physiologic Monitoring services, for medically necessary self-
measured blood pressure monitoring, effective June 29, 2023.
Lipectomy (Liposuction) for Treatment of Lipedema: Medically
necessary liposuction for the treatment of lipedema may be covered when
certain coverage criteria are met and with prior authorization,
effective May 28, 2021.
TRICARE Coverage for Over-The-Counter (OTC) Norgestrel: The TRICARE
pharmacy formulary for OTC drugs covers Norgestrel (Opill) tablet with
a doctor's prescription. TRICARE plan copayments or cost-shares may
apply. This addition to the TRICARE drug formulary does not change OTC
coverage of Levonorgestrel (Plan B One-Step Emergency Contraceptive)
for free without a doctor's prescription. Beneficiaries may see the
TRICARE drug formulary search tool for further information.
Demonstration Changes and Extensions
Childbirth and Breastfeeding Support Demonstration (CBSD)
Childbirth Support Services Adjustments: The CBSD will continue into
calendar year 2025 and is available to all beneficiaries except those
enrolled in USFHP, the Continued Health Care Benefit Program, and those
receiving TRICARE coverage under TRICARE for Life, with the following
adjustments.
First, starting January 1, 2025, all Certified Labor Doulas (CLDs)
performing services under the CBSD must have an agreement to
participate with TRICARE, which means the CLD must file claims and
accept TRICARE reimbursement as payment in full. Beneficiaries must
select a CLD who has agreed to participate (in-network or out-of-
network) to have TRICARE pay for services. No coverage will be provided
for services received from a CLD without a TRICARE participation
agreement. Beneficiaries who select a TRICARE-participating CLD will
have no out-of-pocket expenses (after the annual deductible has been
met). Second, the allowance for six untimed visits with a CLD either
before or after delivery are replaced by six hours of visits, which can
be used in 15-minute increments for visits of different lengths. Third,
TRICARE raised the reimbursement rates for CLDs. Fourth, the National
Black Doula Association has been added as an accepted certifying
organization for CLDs. Finally, TRICARE is waiving the certification
requirement for CLDs with active Medicaid participation in the state
where practicing. Phase 1 will end on January 1, 2025, and a new Phase
2 reimbursement for childbirth support services provided in the 50
United States and District of Columbia will be effective from January
1, 2025, through December 31, 2026. For overseas locations, the
effective date for Phase 2 reimbursement is also January 1, 2025,
through December 31, 2026.
CBSD Overseas: Starting January 1, 2025, beneficiaries enrolled to
the TRICARE Overseas Program (TOP) are eligible for demonstration
services (doula support and breastfeeding support by authorized
demonstration providers) when all demonstration requirements are met.
Unlike in the U.S., TOP beneficiaries must enroll in the CBSD with the
overseas contractor to be eligible. Beneficiaries can search provider
directories to locate CBSD providers near them in Germany, Japan,
Italy, South Korea, Puerto Rico, and the United Kingdom; in other
countries, the overseas contractor will work with the enrolled
beneficiary to find a qualified provider, if available.
Preventive Service Changes
Pre-Exposure Prophylaxis (PrEP) for, for the Prevention of HIV
Acquisition: Effective January 1, 2025, HIV pre-exposure prophylaxis
with effective antiretroviral therapy (i.e., Apretude), as
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well as related office visits, for adolescents and adults at increased
risk of acquiring HIV, when provided to TRICARE Prime patients of by
network providers to TRICARE Select patients, will be considered
clinical preventive services not subject to cost-sharing.
Digital Breast Tomosynthesis for Breast Cancer Screening as a
Clinical Preventive Services Benefit: DHA will permanently cover
digital breast tomosynthesis (DBT), also known as 3D mammography, as a
clinical preventive services benefit not subject to cost-sharing.
Provisional Coverage Changes
Digital Breast Tomosynthesis for Breast Cancer Screening as a
Clinical Preventive Services Benefit: Provisional Coverage of DBT for
breast cancer screening, which spanned from January 1, 2020, to
December 31, 2024, will lapse. However, as noted above, DHA will
continue to cover DBT as a clinical preventive services benefit not
subject to cost-sharing.
Platelet-Rich Plasma for Major Joint Treatment and Rehabilitation:
Platelet-rich plasma (PRP) injections are excluded from coverage for
all indications. The use of PRP for knee osteoarthritis and lateral
elbow tendinopathy was covered under Provisional Coverage status from
October 1, 2019, to September 30, 2024. Provisional Coverage of PRP
lapsed on September 30, 2024, and will not be replaced with permanent
coverage.
Appendix A
Certain TRICARE enrollee out-of-pocket costs (enrollment fees,
premiums, catastrophic caps, deductibles, and copayments) are adjusted
annually by federal law and regulations based on the annual Cost of
Living Adjustment (COLA) applied to Uniformed Service member retired
pay. A difference in copayments remains between those who joined a
Uniformed Service before January 1, 2018, (Group A), and those who
joined on or after that date (Group B).
The retiree COLA is typically announced after the federal fiscal
year begins in October. Beneficiary out-of-pocket expenses impacted by
the 2025 COLA will be posted to the tricare.mil/changes web page before
the start of TRICARE Open Season, November 11, 2024.
Premium Based Plans
The CY 2025 monthly premiums for TRICARE Reserve Select, TRICARE
Retired Reserve, and TRICARE Young Adult and the quarterly premiums for
Continued Health Care Benefit Program will be posted to the
tricare.mil/changes web page once announced.
Pharmacy Out-of-Pocket Expenses for CY 2025
TRICARE Pharmacy copayments will remain unchanged on January 1,
2025:
Pharmacy Copayments For Calendar Year 2025 *
--------------------------------------------------------------------------------------------------------------------------------------------------------
Retail network
Retail network brand-name Retail network non- Mail order generic Mail order brand- Mail order Non-
Year generic formulary formulary 30-day formulary 30-day formulary 90-day name formulary 90- formulary 90-day
30-day supply supply supply supply day supply supply
--------------------------------------------------------------------------------------------------------------------------------------------------------
2025............................ $16 $43 $76 ** $13 $38 $76
--------------------------------------------------------------------------------------------------------------------------------------------------------
* Active-duty Service members (ADSM) enjoy a $0 copay for covered drugs at any pharmacy.
** For all beneficiaries except ADSM, select brand-name maintenance medications (taken for long-term conditions) may only be filled twice at retail and
then must be filled through home delivery or military pharmacy.
Dated: November 5, 2024.
Stephanie J. Bost,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 2024-26066 Filed 11-7-24; 8:45 am]
BILLING CODE 6001-FR-P