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 |
|Child immunizations |
Children: newborn to age 18
|Adult immunizations |
Adults: age 19 or older
Low to moderate dose statins for the prevention of cardiovascular disease
|Adults: ages 40-75|
Screening for colorectal cancer - bowel evacuant combinations
|Adults: ages 50-75|
|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).