The Record - Additional preventive medications available at no copayment beginning Jan. 1

Additional preventive medications available at no copayment beginning Jan. 1

Under the Women’s Preventive Services mandate of the Affordable Care Act, the Blues currently provide generic oral and injectable prescription contraceptives with no copayment requirement for our female members with commercial pharmacy coverage. Some restrictions apply.*

Beginning Jan. 1, 2014, preventive drug coverage with no member copayment will expand to include additional preventive medications recommended by the U.S. Preventive Services Task Force under the ACA.

Additional preventive drugs that will be covered beginning Jan. 1, 2014, include the following:

Female contraceptives

Generic and select brand over-the-counter female contraceptive products and select prescription brand contraceptive medications

Other mandated preventive medications

Aspirin (OTC) — For men ages 45-79 and women ages 55-79 to prevent cardiovascular disease. Generics only.
Folic acid supplements (OTC) — Females who may become pregnant. Generics only.
Oral fluoride supplements (prescription) — Children ages 6 months to 5 years without fluoride in their water sources. Generics only.
Iron supplements (OTC) — Children ages birth to 12 months who are at risk for anemia. Generics only.
Smoking cessation medications (generic OTC and generic and select brand prescription products) – Members age 18 or older.
Vitamin D (OTC) — Members age 65 or older who are at increased risk for falls. Generics only.

Note: Prescriptions are required for both prescription and OTC products in order for medications to be covered.

Mandated preventive drug coverage with no copay

Female contraceptives

Copayment

Generic oral and injectable prescription contraceptives

Covered in full

Generic and select brand OTC contraceptives (female condom^a, sponge, vaginal film, vaginal foam)

Covered in full^a

NuvaRing^{® b}, Ortho Evra Patch^{® c}

Covered in full^{b, c}

Other mandated preventive drugs

Copayment

Generic drugs: OTC and prescription

Covered in full

All generic and select brand smoking cessation drugs (Chantix^{® b}, Nicotrol^{® b}, Nicotrol NS^{® b})

Covered in full ^b

^a Male contraceptives (e.g., male condoms) are not covered under the ACA.

^b BCBSM and BCN members must meet step-therapy criteria to be eligible for no copay. Applies to NuvaRing, Chantix, Nicotrol and Nicotrol NS.

^cBCN members must meet step-therapy criteria to be eligible for no copay for Ortho Evra Patch.

This information applies to all commercial members, but not to Medicare Advantage members. As always, be sure to check group-specific benefits for complete details.

*Grandfathered groups and retiree opt-out groups are exempt from the mandate. Groups not included in the mandate are BCN Advantage HMO-POS^SM (except BCN Advantage with commercial pharmacy rider), Blue Cross Complete, BCN 65 non-group and MyBlue Medigap^SM.

Some group health plans sponsored by certain religious employers are exempt from the requirement to cover contraceptive services. In addition, there are some nonprofit employer groups that were granted a delay on the implementation of this benefit until their first plan year on or after Aug. 1, 2013, based on their religious beliefs.

The information in this document is based on preliminary review of the national health care reform legislation and is not intended to impart legal advice. The federal government continues to issue guidance on how the provisions of national health reform should be interpreted and applied. The impact of these reforms on individual situations may vary. This overview is intended as an educational tool only and does not replace a more rigorous review of the law’s applicability to individual circumstances and attendant legal counsel and should not be relied upon as legal or compliance advice.

No portion of this publication may be copied without the express written permission of Blue Cross Blue Shield of Michigan, except that BCBSM participating health care providers may make copies for their personal use. In no event may any portion of this publication be copied or reprinted and used for commercial purposes by any party other than BCBSM.

*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2012 American Medical Association. All rights reserved.