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Preventive drugs are covered under all of our prescription drug plans; grandfathered and non-grandfathered. However, some plan options provide enhanced coverage of preventive drugs.
Pharmacy Preventive Drug Enhanced Benefit for HDHP Members
The preventive drug enhanced benefit is available on specific high deductible health plans; check your member guide to see if your group has selected this optional benefit that waives the deductible for preventive drugs. Preventive drugs are those considered to be used for preventive purposes if it is being prescribed primarily (1) to prevent the symptomatic onset of a condition in a person who has developed risk factors for a disease that has not yet become clinically apparent or (2) to prevent recurrence of a disease or condition from which the patient has recovered. A drug is not considered preventive if it is being prescribed to treat an existing, symptomatic illness, injury or condition.
To see the current list of drugs available under this benefit, click here. Please note this list is subject to change and will be updated on a periodic basis.
Pharmacy Preventive Benefits Related to PPACA
The Patient Protection and Affordable Care Act (PPACA) provides for the coverage of in-network preventive benefits with no cost sharing for non-grandfathered plans. The information below lists Blue Cross and Blue Shield of North Carolina's (BCBSNC) preventive care services for non-grandfathered health care reform compliant plans. For more information specific to your preventive benefits, please check your member guide. Preventive services are based on government recommendations.
Women's Preventive Care services, recommended by the Health Resources and Services Administration, are effective for individual and new / renewing non-grandfathered groups as of August 1, 2012. Contraceptive coverage will include diaphragms, injectables, Nuvaring, Ortho Evra (aka "the patch") and generic oral contraceptives with no member cost-sharing. All medications will require a prescription. Brand oral contraceptives will continue to require member cost sharing (e.g. deductible, copay and / or coinsurance). Emergency contraception (aka "the Morning After pill") will be covered as preventive for members under 18, and will require a prescription. For a complete list of generic contraceptives covered as preventive, click here.