TRICARE Clinical Trials: Coverage & Authorization Guide
TRICARE generally covers the "routine costs" of participation in certain medical clinical trials, provided the trial is sponsored by the National Cancer Institute (NCI) or other approved government agencies. While TRICARE does not pay for the experimental drug or device itself, it covers the standard doctor visits, lab tests, and hospital stays you would have received even if you weren't in the trial.
*Note: TRICARE.com is an independent reference site and is not affiliated with the Department of Defense. For official policy, visit TRICARE.mil.*
Details
TRICARE follows specific federal guidelines regarding clinical trials to ensure patient safety and medical necessity. Participation is usually divided into two categories: Cancer Clinical Trials and trials for other life-threatening conditions.
### Approved Clinical Trials To be covered by TRICARE, the trial must be a **Phase I, Phase II, or Phase III** study. TRICARE typically identifies eligible trials through partnerships with: * The National Cancer Institute (NCI) * The Department of Defense (DoD) * The Department of Veterans Affairs (VA)
### What TRICARE Covers TRICARE covers "routine clinical care" which includes: * Standard diagnostic tests and X-rays required for the study. * Physician services and hospital stays. * Administration of the investigational item. * Treatment of complications resulting from the trial.
### What TRICARE Does NOT Cover You or the trial sponsor are responsible for: * The experimental drug, device, or procedure itself (these are usually provided for free by the study sponsor). * Data collection and record-keeping required by the study. * Travel, lodging, or food expenses (unless specifically authorized under a separate benefit).
### Requesting Authorization You cannot simply join a trial and send TRICARE the bill. You must: 1. **Get a Referral:** Your doctor must provide a referral for the trial. 2. **Obtain Pre-authorization:** Your regional contractor (Humana Military in the East or TriWest in the West) must approve the participation before you begin. 3. **Establish Medical Necessity:** The trial must be for a condition where no standard medical treatment is effective or appropriate.
### Costs and Copays (2026 Rates) If you are using TRICARE Prime, your copays for routine care within a trial are typically $0. For TRICARE Select, your standard cost-shares apply based on your beneficiary group (Group A or Group B). For 2026, retirees on TRICARE Select generally face a deductible and a percentage of the allowable charge for outpatient visits; check your specific plan details as these vary by sponsor status.
## Who this affects * **Active Duty Service Members:** Must have a referral and fitness-for-duty clearance. * **Active Duty Family Members:** Covered under Prime or Select with pre-authorization. * **Retirees and their Families:** Covered, though cost-shares apply for TRICARE Select users. * **National Guard and Reserve:** Eligible if enrolled in TRICARE Reserve Select. * **Survivors:** Eligible according to their specific plan (Prime or Select).
## Sources * **TRICARE.mil:** [Clinical Trials Overview](https://www.tricare.mil/clinicaltrials) * **National Cancer Institute (NCI):** [Federal Programs and TRICARE Coverage](https://www.cancer.gov) * **TriWest Healthcare Alliance:** [West Region Clinical Trial Authorization](https://www.triwest.com) * **Humana Military:** [East Region Benefits and Authorizations](https://www.humanamilitary.com)