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Tricare Breast Pump Prescription

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Breast Pump Prescription Form 

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Getting Started (UTM Test)

New Getting Started (UTM Test)

Mom’s Information

Address(Required)
Please enter a valid phone number.
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Baby’s Information

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Doctor’s Information

Doctor's Name(Required)
Please enter a valid phone number.
Max. file size: 50 MB.
If you have a prescription, you can upload it here. Otherwise, we can fax a request to your Doctor.

Insurance Company Information

Tricare members please use DOD Benefits Number (DBN) or Sponsors Social
This should be the Member’s Services phone number.
Tricare members please use Benefits Number (11 digits) or Sponsors Social.
This should be the Member’s Services phone number.

Select Your Breast Pump

Select from the breast pumps below and we’ll begin the confirmation and shipping process.

Motif

Motif
Less than half a pound, the quiet Duo fits in one hand and discreetly slips into any bag.
Motif
For busy moms Motif offers a rechargeable battery-powered version of the Luna with a battery life of 2+ hours between charges.
Motif
Sophisticated, strong, and soothing. The Luna is the powerful breast pump from Motif Medical, built for modern motherhood.

Medela

Medela
The Pump In Style Advanced Breastpump Starter Set is part of Medela’s patented 2-Phase Expression technology pump family.
Medela
The compact design and USB-chargeable battery give you flexibility with no compromise on pumping performance.

Spectra

Spectra
For moms wanting complete portability and flexibility so they can pump how they like, when they like and where they like.
Spectra
Boasting every innovation possible to make life easier for you, including powerful 300mmHg suction, double pumping, and much more.
Spectra
This pump is absolutely quiet and is the most portable and stylish hospital grade pump around.

Other Premium Brands

Other Premium Brands
With Elvie Pump you can lead the conference call, play with your kids, or enjoy some peace and quiet… all while you pump
Other Premium Brands
Designed to be compact with features the world’s only FDA-cleared pump kit that helps protect breast milk from contaminants.
Other Premium Brands
Take Back Your Freedom with the BabyBuddha Complete Kit. Designed to free your hands and enhance your productivity.