After a Defense Department watchdog last year found Tricare overpaid more than $16 million for breast pumps, the military insurance provider has scaled back its coverage of those devices for new moms.
The new policy cuts out coverage of “luxury or deluxe” features, such as connectivity to cars and smartphones, as well as associated products like nursing bras, cleaning supplies and over-the-counter ointments.
New mothers will also be limited to one breast pump kit per birth — not two, as was previously allowed.
The new policy comes after a 2018 Office of Inspector General investigation of Tricare spending in its north, south and west regions found that the Defense Health Agency overpaid for breast pumps in 91 percent of cases. And by not using suppliers with fixed reimbursement rates, it had also overpaid for replacement parts in 57 percent of cases, the report said.
As a result, DHA overpaid a total of $16.2 million for standard electric breast pumps and replacement parts and could have ended up overpaying an additional $81.2 million over the next five years.
Tricare spokesman Kevin Dwyer said that while the new policy responds to the Inspector General’s findings to eliminate overspending, it also improves coverage for Tricare beneficiaries.
The policy “set limits in line with the manufacturer recommendations and best clinical practices” and “adds coverage of additional breastfeeding supplies, including nipple shields and supplemental nursing systems,” he said in an email.
The changes retroactively apply since July 5, 2018. Dwyer could not immediately say what that means for moms who have purchased or received a breast pump and related supplies through Tricare in the months since.
Women in their third trimester of pregnancy, or who give birth prior to 27 weeks, are eligible to get manual or standard electric breast pumps, supplies and breastfeeding counseling through Tricare. New moms who adopt infants are also eligible for the benefit.
Natalie Gross has been reporting for Military Times since 2017. She grew up in a military family and has a master's degree in journalism from Georgetown University.