June 26, 2019

TRICARE now covers Banked Donor Milk (BDM) for infants with certain serious health conditions. Coverage applies if the mother’s milk is contraindicated, unavailable or is insufficient in quantity or quality to meet the infant’s need AND the infant has one or more of the following conditions:

• Born at very low birth weight – less than 1,500 grams or lower, < 1,000 grams
• A disorder or surgery where the baby’s digestive needs require additional support
• Diagnosed with failure-to-thrive (not appropriately gaining weight or growing)
• Formula intolerance with either documented feeding difficulty or weight loss
• Low blood sugar
• Heart disease
• Organ transplant or
• Other serious health condition and the use of BDM is medically necessary for the treatment recovery of the infant

A TRICARE-authorized provider has to prescribe BDM, as well as actively manage the infant’s care. BDM must be obtained through a Humana Milk Banking Association of North America (HMBANA) accredited milk bank and delivered through a TRICARE-authorized provider (example: pediatrician or inpatient hospital or the supplier [HMBANA-accredited milk bank]). Coverage is limited to no more than 35 ounces per day, per infant.

For more information, visit TRICARE.mil

Provider resources:

• BDM FAQs
• Request for BDM
• Become a TRICARE-certified donor milk bank