The shortage of infant formula is impacting millions of families. This includes military families living in the United States and overseas. It is important that you know what TRICARE covers and does not cover. Here are some questions and answers about infant formula coverage to help you.
“The formula shortage is a concerning and difficult situation that the Defense Health Agency takes seriously,” said Elan Green, chief of the member benefits and reimbursements section of TRICARE Health Plan. “We understand that parents are worried. We know that clear information can help you through this difficult time.
Q: Does TRICARE cover infant formula?
A: TRICARE covers medically necessary infant formula. This includes:
- Regular infant formula for children who have feeding tubes (separately, TRICARE also covers specialty formula for adults or older children with feeding tubes or who cannot eat solid foods)
- Protein-rich formula for infants on a ketogenic diet to control seizures
- Special formulas for those who cannot digest certain foods or nutrients
Your child’s doctor should diagnose and prescribe a special formula. To note: TRICARE does not cover healthy infant and child formula.
Q: Who can get a medically necessary preparation?
A: If you qualify for medical food coverage, TRICARE can cover your specialty formulas or other medical foods. Remember that care must be medically necessary and appropriate. You can review the types of medically necessary foods covered by TRICARE by visiting the Nutrition Therapy page. The type of formula depends on the medical need.
Q: Does TRICARE ship formula?
A: No. TRICARE does not ship infant formula directly to families.
Q: How much does the prescribed formula cost?
A: Your costs for covered medical foods depend on your health plan. It also depends on your beneficiary category. Visit the TRICARE Costs page and look under “Medical Supplies” to learn more.
Q: What if I can’t get my baby’s prescription formula?
A: If you have a child whose medically necessary formula is not available, you should work with your pediatrician, primary care manager (PCM), or specialist such as a pediatric dietitian. TRICARE will cover your appointments to talk about options for your child.
Q: What are some suggestions for parents trying to feed their babies?
A: Don’t try to make your own formula. The Food and Drug Administration (FDA) “advises parents and caregivers not to make or give homemade infant formula to infants. Homemade infant formula recipes have not been reviewed by the FDA and may be lacking in nutrients essential for an infant’s growth…The agency has received reports of hospitalized babies who had been fed infant formula homemade… which can be life-threatening. The FDA recommends asking your child’s pediatrician, PCM, or specialist for advice on changing your child’s formula or feeding practices. You can go to the FDA website to find other recommendations and warnings for parents trying to find formula.
The American Academy of Pediatrics also encourages you to speak with your child’s doctor if you have any concerns about your baby’s health and nutrition. If your child has special health needs, be sure to consult with their doctor for medically appropriate and safe feeding alternatives.
“We understand this is a very stressful time for military families with babies,” Green said. “Because TRICARE does not have a supply of infant formula, it is best to consult your pediatrician, PCM or specialist.”
If you have any questions about the services or costs covered by TRICARE, you can refer to the TRICARE website. You can also contact your regional TRICARE contractor for more information. Remember that your best resource for guidance and advice on your options is your child’s healthcare provider.
Would you like to receive the latest TRICARE news by email? Visit the TRICARE Subscriptions page today and create your personalized profile to get benefit updates, news and more.