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Use this framework to decide whether to pursue TRICARE coverage or pay cash for compounded tirzepatide: Pursue TRICARE coverage if: You have diagnosed type 2 diabetes (HbA1c 6.5% or higher) Your HbA1c is 7.0% or higher despite current treatment You have tried and failed metformin plus at least one other oral diabetes medication Your provider is TRICARE-authorized and willing to complete prior authorization paperwork You are willing to wait 14 to 28 days for approval Your primary goal is diabetes control (weight loss is secondary) Pay cash for compounded tirzepatide if: You do not have type 2 diabetes Your primary goal is weight loss or obesity management You have prediabetes (HbA1c 5.7% to 6.4%) but not diabetes You want to start treatment within 7 to 10 days You prefer not to involve TRICARE or have a coverage denial on record You are comfortable with the $297 to $399 per month cost Contact your provider for guidance if: You have type 2 diabetes but your HbA1c is below 7.0% You have been denied TRICARE coverage and want to appeal You are using compounded tirzepatide and develop diabetes (may become eligible for TRICARE coverage) You are unsure whether your diagnosis qualifies as type 2 diabetes The decision is not always binary

PMID 25826322