Changes to TRICARE Coverage of Prostate Exams

TriWest Healthcare Alliance recently was notified that TRICARE Management Activity (TMA) implemented changes regarding the physical examination for prostate cancer of male TRICARE beneficiaries.

Here are the change highlights:

• Changes digital rectal examination from "should be performed" to "will be offered."
• Changes annual testing for all men over 50 to "offer testing to all men over 50 who have at least a 10-year life expectancy."
• Changes annual testing for men 40-to-49 with family history of prostate cancer to "offer testing for men over 45 with at least one first degree relative under age 65 diagnosed with prostate cancer and start offering testing for men at 40 with two or more family members with prostate cancer."
• Adds offering annual testing for all African American men aged 45 or over, regardless of family history.

Changes regarding the annual testing for the following categories of males were as follows:

• Changes prostate-specific antigen annual testing for men 40 and older with a family history of prostate cancer to "men 45 and older with one family member with a history of prostate cancer."
• Adds testing for all African American men 45 and older regardless of family history.
• Adds testing for men 40 and older with two family members with history of prostate cancer.
• Changes discontinuation of screening at age 70 to continue to "offer screening as along as there is 10 year life expectancy."

For further information about the changes, please refer to the TRICARE Policy Manual, Chapter 7, Section 2.1, Clinical Preventive Services. All TRICARE manuals can be found at www.tricare.mil.