Does TRICARE cover allergy testing and shots?
Quick Answer
TRICARE covers allergy skin testing, blood tests, allergy shots (immunotherapy), and prescription allergy medications. Prime requires a PCM referral to an allergist. Standard copays apply based on your plan and provider type.
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Key Takeaways
- Allergy testing, shots, and medications are covered by TRICARE
- Prime requires a PCM referral to see an allergist
- Immunotherapy (allergy shots) is covered during build-up and maintenance phases
- Generic allergy medications can save on prescription copays
Detailed Answer
TRICARE provides comprehensive coverage for allergy diagnosis, testing, and treatment including immunotherapy (allergy shots).
Covered Allergy Testing
- Skin prick testing (most common)
- Intradermal skin testing
- Blood tests (specific IgE, RAST testing)
- Patch testing for contact allergies
- Food allergy testing when medically indicated
- Environmental allergen panels
Allergy Shots (Immunotherapy)
- Covered when prescribed by an allergist
- Build-up phase (weekly injections for 3-6 months)
- Maintenance phase (monthly injections for 3-5 years)
- Sublingual immunotherapy (under-the-tongue tablets) may be covered
- Must be administered in a medical setting with monitoring
Allergy Medications
- Prescription antihistamines covered through TRICARE pharmacy
- Nasal corticosteroid sprays
- Epinephrine auto-injectors (EpiPens) for severe allergies
- Eye drops for allergic conjunctivitis
- Some over-the-counter allergy medications may require a prescription for coverage
Referral and Access
- TRICARE Prime: PCM referral needed to see an allergist
- TRICARE Select: Direct access to network allergists without referral
- MTFs may have allergy clinics available
- Pre-authorization generally not required for standard testing
Costs
- Active duty: No cost
- Active duty families (Prime): Low or no copay for network care
- Retirees (Prime): Standard specialist copay
- Retirees (Select): Cost-share based on network/non-network
- Allergy shots: Copay per visit during build-up and maintenance
What May Not Be Covered
- Unproven or experimental allergy treatments
- Alternative allergy therapies not supported by evidence
- Over-the-counter medications without a prescription
- Environmental modifications to your home
Tips for Managing Allergies
- Keep a symptom diary before your allergist appointment
- Bring a list of all current medications to your visit
- Ask about generic alternatives for allergy medications
- Discuss whether immunotherapy is right for your type of allergies
Helpful Tips
- Keep a symptom diary to help your allergist determine the best testing approach
- Ask your PCM for a referral to an allergist if over-the-counter treatments are not working
- Use home delivery pharmacy for maintenance allergy medications to save on copays
Related TRICARE Terms
Related Questions
Does TRICARE cover prescriptions?
Yes, TRICARE covers most prescriptions through military pharmacies, network pharmacies, and home delivery.
What's the difference between a referral and prior authorization?
Referrals allow you to see specialists (Prime requirement). Prior authorization is approval needed before certain services regardless of plan.
What services does TRICARE cover?
TRICARE covers preventive care, doctor visits, hospitalization, surgery, mental health, maternity, prescriptions, and more with some requiring authorization.
What do most military families add to their TRICARE coverage?
Supplemental health insurance is the most common addition — it covers dental, vision, and out-of-pocket costs that TRICARE leaves uncovered. Life insurance and a legal will are also highly recommended.
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