Home Infusion Therapy

TRICARE covers home infusion therapy. Home infusion therapy means taking medicine in your home in a way other than swallowing it. This could be:

  • A shot in your muscles
  • Given beneath your skin
  • Given through your veins
  • Infused through a piece of durable medical equipment

You'll pay pharmacy cost-shares for the infusion drugs. You must have pre-authorization from your regional contractor before you get your prescription filled. However, you don't need pre-authorization before getting home infusion therapy if you:

  • live overseas
  • use TRICARE For Life
  • have other health insuranceHealth insurance you have in addition to TRICARE, such as Medicare or an employer-sponsored health insurance. TRICARE supplements don’t qualify as "other health insurance."

Getting Home Infusion Therapy

How you get home infusion therapy depends on whether or not you are homeboundTRICARE considers you homebound if you can’t leave your home without a lot of effort..

If Homebound, You May:

Give yourself the therapy (or
get the therapy from a caregiver)

  • You must get the infusion drug from an approved TRICARE network pharmacy
  • Your doctor must certify that self-administration is medically appropriate. 
Get therapy from an authorized home health agency 
  • The medical supplies and skilled nursing services are covered under the medical benefit.
  • Your health plan's cost-shares/copayments will apply.

If Not Homebound, We May Cover Home Infusion Therapy if:

You need it long-term
  • More than 5 infusions in a row
  • You, a caregiver or a home health agency can be authorized to give the therapy.
  • You must get the infusion drug from an approved TRICARE network pharmacy.
You need it short-term
  • 5 or fewer infusions in a row
  • Only authorized from a home health agency.
  • You must get the infusion drug from an approved TRICARE network pharmacy.

This list of covered services is not all inclusive. TRICARE covers services that are medically necessaryTo be medically necessary means it is appropriate, reasonable, and adequate for your condition. and considered proven. There are special rules or limits on certain services, and some services are excluded.

Last Updated 3/20/2022