Coalbenefits: Approved Preventive Drugs

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) Aspirin tablet Aspirin chew Aspirin delayed release Aspirin dispersible tablet	Men (ages 45-79); Women (ages 55-79); and Pregnant women who are at high risk for preeclampsia
Folic acid supplement* Multivitamin with 0.4mg to 0.8mg of folic acid 1 per day	Women who are planning or capable of pregnancy
Oral fluoride supplement Sodium fluoride products only, not in combination Sodium fluoride tablet 0.5mg Sodium fluoride chew tablet 0.25mg to 0.5mg Sodium fluoride solution	Children – newborn to five years whose primary water source is deficient in fluoride
Tobacco-cessation drugs Zyban – up to 360 tablets/year Chantix – up to 360 tablets/year Nicotine TD patch 24-hour kit – up to 180 patches/year Nicotine polacrilex gum 2/4 mg Nicotine polacrilex lozenge 2/4 mg Nicotrol nasal spray Nicotrol inhaler	Adults who use tobacco products
FDA-approved contraceptives FDA-approved contraceptive methods, sterilization procedures, and patient education and counseling Abortifacients are not included as contraceptives Products covered: Oral contraceptives Patch and vaginal contraceptives Emergency contraceptives Injectable Diaphragms Spermicides Sponges Cervical caps Female condoms Progestin IUD Progestin implants	Women
Child immunizations Haemophilus Influenza Type B Hepatitis A and B Human Papillomavirus Inactivated Poliovirus Influenza Measles, Mumps, & Rubella Meningococcal Pneumococcal Rotavirus Tetanus, Diphtheria, & Pertussis (whooping cough) Varicella	Children: newborn to age 18
Adult immunizations Hepatitis A and B Human Papillomavirus Influenza Measles, Mumps, & Rubella Meningococcal Pneumococcal Tetanus, Diphtheria, & Pertussis (whooping cough) Varicella (chickenpox) Zoster (Herpes Zoster)	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 Generic only Prescription only 1 per day Fluvastatin excluded from 100% coverage; see Covered Medication Search	Adults: ages 40-75
Screening for colorectal cancer - bowel evacuant combinations Over-the-counter (OTC) requires a prescription Oral magnesium citrate Polyethylene glycol 3350	Adults: ages 45-75
Breast cancer prevention - Tamoxifen and Raloxifene (Evista) Requires prior authorization 1 per day	Women: ages 35 and older
Pre-Exposure Prophylaxis (PrEP) for HIV infection Descovy and Truvada 1 per day	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).