Approved Preventive Drugs
The following drugs are covered at the Approved Preventive Drugs benefit level shown in "Highlights of the Plan," within the frequency, dosage, and patient-age limits described below. This list is subject to change at any time.
Over-the-counter products (noted with an asterisk (*) below) are covered only 1) if your health care provider provides a written prescription, and 2) if dispensed at an on-site clinic (unless a clinic is not available at your mine/office, in which case it is covered 100% at an In-Network retail pharmacy).
The Approved Preventive Drugs benefit level is 100% coverage for eligible generic drugs. Eligible brand-name preventive drugs are covered at 100% only if there is no generic alternative available. If you choose a brand-name preventive drug when a generic is available, you are subject to cost-sharing as shown in "Highlights of the Plan."
Preventive Drug | Coverage for: |
---|---|
Low-dose aspirin* for the prevention of cardiovascular disease, colorectal cancer, or pregnancy preeclampsia (1 per day, 81mg)
|
Men (ages 45-79); |
Folic acid supplement*
|
Women who are planning or capable of pregnancy |
Oral fluoride supplement
| Children – newborn to five years whose primary water source is deficient in fluoride |
| Adults who use tobacco products |
FDA-approved contraceptives
| Women |
Child immunizations
| Children: newborn to age 18 |
Adult immunizations
| Adults: age 19 or older |
COVID-19 vaccinations (and their administration) that have received a recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention (CDC). The current list of vaccines can be found at https://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/covid-19.html. The Plan also covers other COVID-19 preventive services that have in effect a rating of A or B in the current recommendations of the United States Preventive Services Task Force. | All members (subject to current CDC age guidelines) |
Low to moderate dose statins for the prevention of cardiovascular disease
| Adults: ages 40-75 |
Screening for colorectal cancer - bowel evacuant combinations
| Adults: ages 45-75 |
Breast cancer prevention - Tamoxifen and Raloxifene (Evista)
| Women: ages 35 and older |
Pre-Exposure Prophylaxis (PrEP) for HIV infection
| Adults: ages 18 and older |
* Covered only 1) if your health care provider provides a written prescription, and 2) if dispensed at an on-site clinic (unless a clinic is not available at your mine/office, in which case it is covered 100% at an In-Network retail pharmacy).