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September 2014

Tamoxifen, raloxifene added to PPACA preventive drug coverage list

Beginning Sept. 30, 2014, generic tamoxifen and raloxifene will be eligible for coverage with no cost-sharing when prescribed for primary prevention of breast cancer in women at high risk. This change affects our commercial health plan members with Blue Cross Blue Shield of Michigan or Blue Care Network prescription coverage.

These additions are recommended by the U.S. Preventive Services Task Force under the Affordable Care Act.

Members must meet plan requirements and a prescription is required for coverage. To request a review for a patient to receive these drugs at $0 copay, prescribers can contact the Pharmacy Clinical Help Desk at 1-800-437-3803. Members can call the Customer Service number on the back of their Blues member ID card. Cost-sharing will continue to apply when these drugs are prescribed as a treatment for breast cancer.

The ACA preventive drug coverage list will be updated on Sept. 30, 2014. To access the ACA preventive drug coverage list, please click here.

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