The Defense Health Agency developed this digital toolkit to help you communicate with beneficiaries about contraceptive care with TRICARE. This comprehensive communication campaign focuses on raising awareness of contraceptive options as well as drawing attention to recent copayment waivers.
Background
TRICARE provides beneficiaries with contraceptive care coverage. Access to comprehensive contraceptive counseling is critical to address the timing and choice regarding family planning and prevention of pregnancy. It’s also integral to addressing other medical conditions, and the management and suppression of menstruation.
To increase contraceptive choices, TRICARE is waiving copayments and cost-shares on medical contraception such as long-acting reversible contraceptives (LARCs) and permanent contraception. This toolkit aims to inform TRICARE beneficiaries on the improvements to contraceptive care and increase beneficiary choices of type and form of contraceptive care available.
What's Changing?
Effective July 28, 2022, copayment and cost-shares were waived for long-acting reversible contraceptives.
- Phase 1: Copayments and cost-shares for long-acting reversible contraceptives services such as placing and removal of IUDs, contraceptive shots, and subdermal contraceptive rods will be waived beginning Nov. 1, 2022.
- Phase 2: Copayments and cost-shares for tubal litigation, a form of permanent contraception, will be waived for TRICARE Prime and TRICARE Select beneficiaries beginning Jan. 1, 2023.
Beneficiaries who are charged a copayment when they receive these procedures between July 28, 2022, and the implementation date have to pay applicable copayments or cost-shares at the point of care. However, beneficiaries may request reimbursement any copayments or cost-shares by having their claims reprocessed after the appropriate implementation date.
Beneficiaries should talk to their doctor or primary care manager about what contraceptive care is available to them and how to receive it. More information on TRICARE coverage of contraceptive care can be found at www.tricare.mil/birthcontrolTRICARE webpage.
What TRICARE Covers
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Yes. Your TRICARE pharmacy benefit covers the prescription contraceptives below:
- birth control pill
- birth control patch
- birth control shot
- birth control vaginal ring
- cervical cap
- diaphragm
- foams, jellies, sprays, or sponges that need a prescription
- Emergency contraceptives (e.g., Plan B or Ella)
To learn more about what is covered, review the Contraception Chart page. Use the TRICARE Formulary Search Tool to see costs.
Your TRICARE medical benefit covers the contraceptive methods below and any associated medical procedures:
- birth control implant
- insertion, removal, and repositioning of an IUD (intrauterine device)
- vasectomy
- tubal ligation
TRICARE doesn’t cover:
- condoms (including female condoms)
- foams, jellies, sprays, or sponges that don't need a prescription
- hysterectomy for the purpose of contraception
- reversal of vasectomy, unless it's medically necessary
- reversal of tubal ligation, unless it's medically necessary
To learn more, visit the Contraception Chart page.
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Yes. As of July 28, 2022, you no longer pay for the medical contraceptives below if you get the service from a TRICARE network provider:
- Insertion, removal, and repositioning of an IUD (intrauterine device)
- Birth control shot
- Birth control implant
- Diaphragm measurement and fitting
The TRICARE contractors process these claims with no copayment starting Nov. 1, 2022. Call your TRICARE contractor after 1 Nov. to ask them to reprocess claims for medical contraceptives services you received after 28 July.
Under TRICARE Prime, you may receive care from a non-network provider if you have a referral from your Primary Care Manager before you get care.
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Prescription cost-shares are set in law. Congress would have to change the law to waive copayments. Remember, you have no copayments when you fill a covered prescription at a military pharmacy.
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If you paid for one of the services below from a TRICARE network provider, call your TRICARE contractor and ask them to reprocess your claim.
- Insertion, removal, and repositioning of an IUD (intrauterine device)
- Birth control shot
- Birth control implant
- Diaphragm measurement and fitting
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Yes. If you get this service before January 2023, you will pay a copayment or cost-share. Starting January 2023, you won’t pay anything for a tubal ligation if you get the service from a TRICARE network provider?
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Military pharmacies and the TRICARE pharmacy benefit cover oral emergency contraceptives, such as Plan B One-Step and ella.
- Non-prescription emergency contraceptive. Plan B One-Step is available at military pharmacies or retail network pharmacies.
- You don’t need a prescription.
- There is no copayment.
- You may buy it in many military exchanges, pharmacies, and other local retailers. You must file a claim for reimbursement.
- If you buy these from a non-network retail network pharmacy, you may file claims with the pharmacy contractor for possible reimbursement at the non-network retail pharmacy rate.
- Prescription emergency contraceptive. ella is available, with a prescription, at military or retail network pharmacies. You will pay a copayment at retail network pharmacies. (Active duty service members don’t pay for any prescription drugs.)
At a retail network pharmacy, you (or a friend or partner picking up for you) must provide documentation of patient identity and TRICARE eligibility. This is generally a Uniformed Services ID card. The pharmacy needs this to process purchase as a TRICARE Pharmacy claim. Use the TRICARE Formulary Search Tool to get cost information.
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Yes. You may have to pay a copayment for pharmacy contraceptives—like birth control pills and patches—depending on where you fill your prescription. (Active duty service members don’t have to pay for prescription drugs.)
TRICARE covers prescriptions through its pharmacy benefit.
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For prescription contraceptives (for example, birth control pill or diaphragm) you pay your pharmacy copayment. Use the TRICARE Formulary Search Tool to see your costs.
Medical Contraceptives:
Starting Nov. 1, 2022, you won’t pay for the medical contraceptives below if you get the service from a TRICARE network provider. The change goes back to July 28, 2022. If you paid for one of the services on or after July 28, 2022, call your TRICARE contractor and ask them to reprocess your claim.
- Insertion, removal, and repositioning of an IUD (intrauterine device);
- Birth control shot; and
- Birth control implant.
If you’re enrolled in TRICARE Prime and you use a non-network provider without a referral, you will pay the higher Point of Service costs.
For a vasectomy or tubal ligation (tubes tied), your costs depend on:
- Who you are (active duty family member, retiree, etc.);
- Your beneficiary group (group A or B); and
- Which plan you're using (TRICARE Prime, TRICARE Select, TRICARE Prime Overseas, TRICARE Reserve Select, etc.).
Note: Starting Jan. 1, 2023, you will not pay anything for tubal ligation if you get the service from a TRICARE network provider.
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Yes. By Jan. 2023, every military hospital or clinic must have a contraceptive care clinic. You won’t need an appointment to get services at these clinics. The clinics will offer the full range of contraceptive methods and services. Priority will go to active duty service members, then other beneficiaries on a space available basis. This includes both short and long acting contraceptives.
- Short acting examples: birth control pill, patch, or ring
- Long acting examples: intrauterine devices (IUDs), implants, and shots
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As of Oct. 1, 2022, 18 military hospitals or clinics stateside and overseas have a contraceptive care clinic. It’s open at least one day per week.
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DOD will continue providing IUDs and other contraceptive care in MTFs, consistent with federal law, regardless of state law restrictions.
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DOD will continue to provide Plan B, ella, and other contraceptive care in MTFs, consistent with federal law, regardless of state law restrictions.
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You may be able to get most services from your primary care provider, (for example, prescription for birth control pills). Some trained primary care providers and women’s health providers may offer long-acting contraceptive products (LARCs). They include products like implants, shots, and IUDs.
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No. Home delivery isn’t for conditions where timing is critical.
Walk-In Contraceptive Services
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A resource within a military hospital or clinic where you can come during set hours to get comprehensive contraceptive care in a single visit. This is a place where you can discuss your reproductive thoughts, goals, and contraception needs with a medical provider. Together, you will decide on the option that meets your reproductive needs. This service is designed to be a single appointment reducing the need for referrals and multiple appointments.
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Walk-in contraceptive services improve access to contraceptive care and counseling, which is an essential part of beneficiaries’ health care. Reproductive health decisions, including family building and menstrual regulation, are important parts of overall health, wellness, and quality of life.
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Walk-in contraceptive services will be staffed with health care personnel that may include physicians, certified nurse midwives, nurse practitioners and/or physician assistants who are trained and educated in the full range of contraceptive methods, to include appropriate credentialing for long-acting reversible contraceptives (LARC) placement.
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All active duty service members are able to use walk-in contraceptive services. Also, on a space available basis, eligible beneficiaries who can get pregnant (for example, women, transgender males, non-binary individuals) can also use the walk-in services.
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Can eligible beneficiaries under 18 use walk-in contraceptive services? Yes, if space is available. Check the military hospital or clinic website for hours and days of operation at your location.
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Walk-in contraceptive services will include:
- Pregnancy screening
- Contraception counseling
- Access to a full range of contraceptive methods for pregnancy prevention or menstrual suppression including:
- Short-acting reversible contraceptives (SARCs) (for example, pill, patch, ring)
- Hormonal and non-hormonal long-acting reversible contraceptives LARCs (for example, subdermal contraceptive implants, intrauterine devices [IUDS])
- Emergency contraception (for example, oral levonorgestrel, Plan B), ullipristal acetate (ella), and IUDs
- Education on menstrual suppression, which may assist active duty service members before deploying
- Education on barrier contraception (for example, condoms, diaphragms, vaginal caps)
- Education on natural family planning
- Access to testing and treatment for sexually transmitted infections
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You can get your prescriptions at a military pharmacy, retail network pharmacy, or via home delivery. TRICARE doesn’t pay for condoms, gels, foams or creams. You will need to buy these items.
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You can send a secure message to the provider you saw at the walk-in location. The provider may make a recommendation for a follow-up visit. You may also make a primary care or same-day appointment. If it’s an urgent issue or concern, go to the nearest urgent care or emergency department.
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No. You can get contraceptive care in primary care, family medicine, adolescent pediatrics, and women’s health clinics. You may need a referral for some of the specialty clinics and you may have to wait for an available appointment.
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Walk-in appointments are based on availability. Visit your military hospital or clinic website for walk-in contraceptive services hours of operation. If there is no available time on the day you arrive, you have the option of coming back for the next available walk-in appointment.
Talking Points
Senior Leader Talking Points - Copayments Only
- Easy, convenient, and timely access to the full range of contraceptive methods and counseling is a goal of the Military Health System (MHS).
- TRICARE covers a full range of contraceptive methods for beneficiaries.
- As of July 28, 2022, contraceptive medical consultations and services are considered part of preventive health exams. This means that TRICARE beneficiaries no longer have to pay a copayment for the following long-acting reversible contraceptive services:
- Injections
- Placing and removing of intrauterine devices (IUDs)
- Placing and removing of implantable rods
- As of Jan. 1, 2023, cost-sharing for tubal libation is also waived for TRICARE Prime and TRICARE Select when performed by an in-network TRICARE-authorized provider. Cost-sharing may still apply for tubal ligations performed out-of-network.
- Beneficiaries my have to pay a copayment for pharmacy contraceptives, like birth control pills and patches, depending on where they fill their prescription.
- Cost-sharing amounts for prescription pharmaceuticals obtained outside a military hospital or clinic are set in law, and would require a statutory change to waive. However, prescription pharmaceuticals are available to all eligible TRICARE beneficiaries in military hospital or clinic at no cost.
- Beneficiaries can check the costs for their chosen method of contraception at tricare.mil/contraception
- Beneficiaries should talk to their doctor or primary care manager about what contraceptive care is available to them and how to receive it.
- Access to comprehensive contraceptive counseling is critical to address the timing and choice regarding family planning and prevention of pregnancy. It’s also integral to addressing other medical conditions, and the management and suppression of menstruation.
- According to the 2020 DOD Women’s Reproductive Health Survey, roughly 60 percent of both DOD and Coast Guard active duty service women reported current contraceptive use. Approximately three in ten were currently using a highly effective form of contraception.
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