Q&A: Understanding TRICARE coverage of weight loss medications overseas

Do you live overseas? Your weight loss medication (including GLP-1 drugs) may now be covered by TRICARE. You must meet certain eligibility requirements. This article describes these requirements and helps you navigate the basics of getting GLP-1 drugs overseas.

“TRICARE is expanding access to GLP-1 medications for beneficiaries living overseas,” said Dr. Richard Ruck, Chief Medical Officer, TRICARE Health Plan, at the Defense Health Agency. “This coverage ensures that service members and their family members can get the same quality obesity management care abroad that they would receive in the U.S.”

Q: What are GLP-1 medications?

A: GLP-1 medications work to lower blood sugar levels and help promote weight loss. Common examples include Wegovy, Saxenda, Victoza, Zepbound, and Mounjaro.

Q: What does this mean for me?

A: Obesity management now qualifies as a primary condition for GLP-1 medication coverage if you live overseas and are enrolled in one of the following TRICARE plans:

• TRICARE Prime Overseas
• TRICARE Prime Remote Overseas
• TRICARE Select Overseas
• TRICARE Reserve Select
• TRICARE Retired Reserve
• TRICARE Young Adult

You must meet these requirements to qualify for GLP-1 medication coverage for weight loss:

• Have a diagnosis of obesity
• Meet age and Body Mass Index criteria
• Have an evaluation by a TRICARE network provider
• Take part in a weight management plan
• Meet the local prescribing rules
• Live in a country where the drug is available

Q: How do I get started?

A: You’ll need an evaluation from a provider who can treat obesity. Follow the rules of your health plan to make an appointment. This provider must be:

• A TRICARE host nation network provider
• A provider at a military hospital or clinic
• Embassy Health Unit provider with host nation prescribing rights

Before you see a provider, decide where you’ll fill your prescription:

• At a military pharmacy
• At a retail network pharmacy in a U.S. territory
• At a retail pharmacy overseas (not in a U.S. territory)

Where you fill your prescription will determine which prior authorization process you follow, including which form to complete. Keep reading to learn more.

Military pharmacies

1. Check if your military pharmacy carries GLP-1 drugs. If it doesn’t, you’ll need to fill the prescription at a retail pharmacy. Skip to the steps below for retail pharmacies in U.S. territories or overseas.
2. See your military hospital or clinic provider for evaluation and treatment.
3. If your provider determines you need a weight loss drug, you and your provider complete an Express Scripts prior authorization form and return it to Express Scripts. Express Scripts will validate if you meet all criteria for the drug.
4. Once approved, you can fill your prescription at a military pharmacy.

Retail pharmacies in U.S. territories

1. You’ll need to see a TRICARE network provider for evaluation and treatment. This can be your PCM or a specialist. (Note: If you have TRICARE Prime Overseas, TRICARE Prime Remote Overseas, or TYA-Prime, you may see your PCM or a specialist network provider with a referral from your PCM. Be sure to follow the rules of your plan.)
2. If your provider determines you need a weight loss drug, you and your provider complete an Express Scripts prior authorization form. Your provider will send it to Express Scripts. Express Scripts will validate if you meet all criteria for the drug.
3. Once approved, you can fill your prescription at a retail network pharmacy.

Note: If you’re in a U.S. territory, contact https://militaryrx.express-scripts.com/ to learn more about other options for filling these prescriptions.

Retail pharmacies overseas (not in U.S. territories)

1. You’ll need to see a TRICARE network provider for evaluation and treatment. This can be your PCM or a specialist. (Note: If you have TRICARE Prime Overseas, TRICARE Prime Remote Overseas, or TYA-Prime, you may see your PCM or a specialist network provider with a referral from your PCM. Be sure to follow the rules of your plan.)
2. If your provider determines you need a weight loss drug, you and your provider complete an https://www.tricare-overseas.com/beneficiaries/resources/forms. Ask your provider if you should submit the form to International SOS, or if they’ll submit it on your behalf. International SOS will validate if you meet all criteria.
3. Once approved, you can fill your prescription at a retail pharmacy overseas. You’ll need to pay the full cost of the drug up front. You can then file a claim with International SOS for reimbursement, as described in the TRICARE Overseas Program Handbook.

Q: How long will my prior authorization be valid?

A: At all these pharmacy types, your prior authorization will be valid for 12 months.

Q: What happens after 12 months?

A: After 12 months, you must requalify for coverage. Follow the same process you completed to obtain GLP-1 coverage initially.

Q: Where can I learn more?

A:

• Do you get your prescriptions at a military pharmacy or a U.S. territory retail network pharmacy? Visit https://militaryrx.express-scripts.com/. You can learn more about filling prescriptions and the prior authorization process.
• Do you get your prescriptions at a host nation pharmacy outside of the U.S. territories? Visithttp://www.tricare-overseas.com/. You can find overseas providers and learn more about filling prescriptions overseas. Contact the https://www.tricare-overseas.com/contact-us to learn more.
• Do you have a question about an overseas GLP-1 medication claim? Contact http://www.tricare-overseas.com/. They can assist you regardless of your health plan.