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Does TRICARE Cover Contrave in 2026?
Complete guide to TRICARE coverage of Contrave in 2026. Learn about prior authorization requirements, BMI criteria, out-of-pocket costs, and how to get approved for Contrave with your TRICARE plan.
Coverage Summary
TRICARE offers coverage for Contrave under most plans, subject to prior authorization and specific eligibility criteria. Here's what you need to know about getting approved and managing your costs.
Key details: TRICARE covers FDA-approved weight loss medications with prior authorization. Beneficiaries must be enrolled in a weight management program. Generally better coverage than many commercial plans.
Contrave Coverage Under TRICARE
TRICARE evaluates Contrave (opioid antagonist + aminoketone antidepressant combination) based on clinical criteria and your specific plan's formulary. Understanding your coverage options can save you hundreds of dollars per month.
| Criteria | TRICARE Policy |
|---|---|
| Covers Contrave | Covered |
| Requires Prior Authorization | Yes |
| Step Therapy | Yes — must try other medications first |
| BMI Requirement | >=30 or >=27 with comorbidity |
| Covered Drug Types | Wegovy, Saxenda, Contrave, Qsymia |
| Est. Monthly Cost (With Insurance) | $0-$100 (varies by plan tier) |
| Est. Monthly Cost (Without Insurance) | $320 |
How to Get Contrave Approved Through TRICARE
Getting Contrave approved through TRICARE requires a systematic approach. Here's the step-by-step process:
- Confirm your plan covers weight loss drugs — Call TRICARE member services or check your plan documents. Not all employer plans include weight loss medication coverage, even if TRICARE's standard formulary does.
- Document your weight loss history — TRICARE typically requires evidence of 3-6 months of supervised diet and exercise before approving Contrave. Keep records of any programs you've tried.
- Get your BMI officially measured — Your doctor needs to document your current BMI and any weight-related comorbidities (type 2 diabetes, hypertension, high cholesterol, or sleep apnea).
Consider Telehealth as a Faster Alternative
Even with insurance coverage, getting Contrave approved can take weeks. Telehealth providers offer fast access to effective weight loss medications:
| Provider | Starting Price | Consultation |
|---|---|---|
| Remedy Meds — Editor's Pick | $299/mo | 22-min video |
| Hims & Hers | $199/mo | Async only |
| Ro Body | $145/mo | Async |
Next Steps for TRICARE Patients
Whether you're pursuing TRICARE coverage for Contrave or exploring telehealth alternatives, here's what to do next:
- Call TRICARE member services — Ask specifically about Contrave coverage and what documentation you'll need for prior authorization.
- Talk to your doctor — If TRICARE covers Contrave, your doctor will need to submit the prior authorization request with clinical documentation.
- Explore telehealth options — For faster access without insurance hassles, telehealth providers can get you started on effective weight loss medication within 7-10 days.
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