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Does TRICARE cover experimental or investigational treatments?
Verified by TRICARE.com Editorial Team
Updated 2024-12-01
AI-assisted (gemini)
Quick Answer
TRICARE generally doesn't cover experimental treatments. Clinical trials may be an option, and some investigational care has specific provisions.
Key Takeaways
- Generally not covered
- Some clinical trials covered
- Must be proven treatments
- Ask about exceptions
Detailed Answer
Experimental treatment coverage is limited.
General Rule
- Experimental NOT covered
- Investigational NOT covered
- Must be proven treatments
- FDA approval usually required
What Counts as Experimental
- Not FDA approved
- Still in clinical trials
- Not standard of care
- Unproven effectiveness
Clinical Trials
- Some coverage available
- NCI-sponsored trials
- Certain qualifying criteria
- Routine costs may be covered
Exceptions
- Certain cancer trials
- DoD-sponsored research
- Specific waivers possible
- Case-by-case review
What to Do
- Ask about trial coverage
- Request clinical trial benefits
- Appeal denials
- Seek alternative treatments
Related Questions
What does TRICARE NOT cover?
TRICARE does not cover cosmetic surgery, experimental treatments, custodial care, most dental (unless separate plan), or services from non-authorized providers.
How do I appeal a TRICARE decision?
Appeal denied claims or coverage decisions within 90 days by submitting a written appeal with supporting documentation to your regional contractor.