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 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. Click here for more information. Please check your member guide for more information specific to your preventive benefits. Preventive services are based on government recommendations.
Enhanced HDHP Benefit* Pharmacy Preventive Drugs
*NOTE: This benefit is an option groups can select for their employees. Please be sure to check your member guide to see if your group selected this benefit or call the customer service number listed on the back of your ID card to verify benefit eligibility.
The preventive drug enhanced benefit is available on specific high deductible health plans. This is an 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. To see the updated list of drugs available under this benefit effective January 1, 2017, click here. To see the current list of drugs available under this benefit for the NetResults 5 Tier C formulary, click here.
Please note these lists are subject to change and will be updated on a periodic basis.