Guidance to help you understand when your member cost share will be waived for preventive medications and devices

12/9/16 Guidance to help you understand when your member cost share will be waived for preventive medications and devices. The Patient Protection and ...
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12/9/16 Guidance to help you understand when your member cost share will be waived for preventive medications and devices. The Patient Protection and Affordable Care Act (PPACA) requires non-grandfathered group and individual health plans to waive cost share for in-network preventive services, including certain preventive medications and devices. This requirement does not apply to grandfathered plans. If you do not know whether your plan is subject to this requirement, please contact BCBSAZ. There are two important things to remember about this mandate. First, the cost share waiver does not apply if you use an out of network or non-contracted pharmacy provider, so make sure to check your pharmacy provider’s network status. Second, there are some medications and devices that can be used for both preventive care and to treat a medical condition. Cost share is waived only when the medication or device is prescribed for preventive care. The United States Preventive Services Task Force has identified the medications listed below as the recommended preventive medications. The medication must be prescribed for a preventive care purpose. The medications followed by “PL” have Prescription Limitations or Precertification requirements. To learn more about Prescription Limitations and Precertification, please click here.

ASPIRIN Aspirin (PL) chew tablet: 75mg, 81mg tablet: 81mg, 162mg, 325mg COLONOSCOPY PREP KITS Generic Bowel Evacuation combinations CONTRACEPTIVES*

Ella (PL) tablet: 30mg Option 2 (PL) tablet: 1.5mg CONTRACEPTIVES, NON-ORAL Nuvaring (PL) ring: 0.120-0.015 mg/24hr Xulane (PL) (generic for Ortho Evra) patch: 6/0.75/wk

CERVICAL CAPS (PL) DIAPHRAGMS CONTRACEPTIVES, INJECTABLE Medroxyprogesterone Acetate (PL) (generic for Depo Provera) injection: 150mg/ml Depo Provera injection: 104mg/ml CONTRACEPTIVES, EMERGENCY Levonorgestrol , Next Choice (PL) (generic for Plan B) tablet: 0.75mg, Levonorgestrol ,Next Choice, My Way, Take Action, Opcicon (PL) (generic for Plan B One Step) tablet: 1.5mg Plan B , Plan B One Step (PL) tablet: 0.75mg, 1.5mg

FEMALE CONDOMS (PL) ORAL CONTRACEPTIVE, MONOPHASIC Amethia, Ashlyna, Camrese, Daysee (91day), (generic for Seasonique) (PL) tablet 0.15-0.03mg- 0.01mg Amethia Lo, Comrese Lo, Levonorgestrel/Ethinyl (91-day), (generic for LoSeasonique) (PL) tablet 0.1-0.02mg- 0.01mg Apri, Emoquette, Enskyce, Reclipsen, Solia, Desogestrel/ethinyl estradiol, Juleber (generic for Desogen, Ortho-Cept) (PL) tablet 0.15mg/30mcg Jolessa, Quasense, Introvale, Setlakin Levonorgestrel/Ethinyl estradiol (91-day)

(generic for Seasonale) (PL) tablet: 0.15-0.03mg Aviane, Aubra, Larissa, Lessina, Lutera, Orsythia, Sronyx, Falmina, Levonorgestrel/Ethinyl estradiol. Delyla, Vienva (generic for Alesse, Levlite) (PL) tablet: 0.1mg/20mcg Altavera, Levora, Marlissa, Portia, Kurvelo , Levonorgestrel-Ethinyl Estradiol, Chateal (generic for Nordette) (PL) tablet: 0.15mg/30mcg Alaycen, Necon, Nortrel, Cyclafem, Dasetta, Wera, Pirmella (generic for Brevicon, Modicon, Norinyl, Ortho Novum) (PL) tablet: 0.5/35, 1/35 Microgestin, Junel , Gildess , Larin, Noreth/Ethin, Tarina Fe, Noreth/Ethin FE, Blisovi (generic for Loestrin) (PL) tablet: 1mg/20mcg, 1.5mg/30mcg Ocella, Syeda, Zarah, DrospirenoneEthinyl Estradiol (generic for Yasmin) (PL) tablet: 3-0.03mg Sprintec, Mononessa, Mono-Linyah, Norgestimate/Ethinyl, Previfem, Estarylla, Femynor (generic for Ortho-Cyclen) (PL) tablet: 0.25-35mcg

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* For plans that have a waiver of cost share for preventive care, PPACA’s requirement to waive cost share for contraceptive medications and devices will apply on plan or policy years on and after August 1, 2012. If you have a question about if or when this change is effective for your plan, please contact BCBSAZ.

 

12/9/16 Guidance to help you understand when your member cost share will be waived for preventive medications and devices. Kelnor

(generic for Demulen) (PL)

tablet: 1mg-35 mcg Zenchent, Balziva, Briellyn , Philith, Gildagia, Vyfemla ((generic for Ovcon 35) (PL) tablet: 0.4mg-35mcg Zeosa , Zenchent FE, Wymzya FE, Norethindrone/Ethinyl Estradiol-FE (generic for Femcon Fe) (PL) tablet: 0.4 mg-35 mcg norgestrel & ethinyl estradiol, Low-Ogestrel, Elinest, Cryselle (PL) Microgestin FE, Junel FE, Gildess FE, Larin FE, Noreth/Ethin, Noreth/Ethin FE, Blisovi FE (generic for Loestrin FE) (PL) tablet: 1.5mg/30mcg

(generic for Lo/Ovral-28) (PL)

tablet: 0.3mg-30mcg Norethindrone/Ethinyl estradiol FE, Layolis FE Kaitlib FE (PL) (generic for Generess FE) tablet: 0.8 mg/25 mcg CHW Generess FE (PL) tablet: 0.8 mg/25 mcg CHW Necon (PL) tablet: 1 mg/50 mcg Norinyl (PL) tablet: 1 mg/50 mcg Ogestrel (PL) tablet: 0.5 mg/50 mcg Ortho Cyclen (PL) tablet: 0.25 mg/35 mcg Ovcon (PL) tablet: 1 mg/50 mcg Quartette 91-day (PL) tablet: 0.15-0.02/0.025/0.03 mg ð est 0.01mg Rajani, Drospire/Eth Est/Levom Cal (PL) (generic for Beyaz) tablet:3-0.02-0.451mg Taytilla (PL) cap: 1mg-20mcg Ethynodiol Diacetate/Ethinyl Estradiol (generic for Zovia) (PL) tablet: 1mg-50mcg Yaz (PL) tablet: 3-0.02 mg ORAL CONTRACEPTIVE, BIPHASIC Amethyst, Levonogestrel-Ethinyl (PL)

(generic for Lybrel) tablet: 90-20mcg) Necon (PL) tablet: 10/11 ORAL CONTRACEPTIVE,

TRIPHASIC

Velivet, Cesia, Caziant (PL)

(generic for Cyclessa)

tablet: 0.1-0.025/0.125-0.025/0.15.025mg Alaycen, Necon, Nortrel, Cyclafem, Dasetta, Pirmella (PL) (generic for Ortho-Novum 7/7/7) tablet: 0.5-35/0.75-35/1-35 Trivora, Enpresse, Myzilra, Levonorgestrel/Ethinyl Estradiol (PL) (generic for Triphasil, Tri-Levlen) tablet:0.05-30/0.075-40/0.125-30 Aranelle, Leena (PL) (generic for Tri-Norinyl) tablet: 0.5-35/1-35/0.5-35mg Tilia FE, Tri-Legest FE (PL) (generic for Estrostep FE) tablet: 1-20/1-30/1-35mg-mcg Norgest/Ethinyl estradiol, Tri-sprintec, Trinessa, Tri-Previfem , Tri-Linyah, TriEstarylla (PL) (generic for Ortho Tri-Cyclen) Norgest/Ethinyl estradiol, Trinessa Lo, TriLo-Estarylla, Tri-Lo-Sprintec, Tri-Lo Marzia (generic for Ortho Tri-Cyclen Lo) (PL) tablet: 0.18-25/0.215-25/0.25-25 mg-mcg ORAL CONTRACEPTIVE, FOUR-PHASIC Natazia (PL) tablet: 3 mg /2-2 mg/2-3 mg/1 mg ORAL CONTRACEPTIVE, PROGESTINS Camila, Errin, Heather, Jencycla, Jolivette,

Lyza, Nora BE, Norethindrone , Norlyroc,

Sharobel, Deblitane (PL)

(generic for Ortho-Micronor, Nor-Q-D)

tablet: 0.35mg ORAL CONTRACEPTIVE, OTHER Kariva, Azurette , Viorele, Pimtrea, Deso/Ethinyl, Kimidess, Bekyree (PL) (generic for Mircette) tablet: 0.15-0.02-0.02/0.01mg SPERMACIDES (PL)

(e.g., vaginal gel/foam/film/suppositories) SPONGES (PL) FLUORIDE Sodium fluoride (PL) chew tablet: 0.2mg, 0.5mg, 1mg cream: 1% drops: 0.125mg, 0.25mg, 0.5mg gel: 1.1% lozenge: 1mg paste: 1.1% rinse 0.05% solution: 0.05%, 0.2%, .5%, 1mg tablet: 0.5mg, 1mg FOLIC ACID Folic Acid (PL) tablet: 1mg HORMONAL ONCOLOGICS Tamoxifen tablet: 10mg, 20mg Raloxifene (PL) tablet: 60mg IRON Ferrous sulfate (PL) drops: 75mg/ml, 75mg/0.6ml oral liquid: 5mg/20ml SMOKING CESSATION Bupropion HCL Smoking Deterrent (PL) tablet: 150mg Chantix (PL) tablet: 0.5mg, 1mg Commit (PL) lozenge: 2mg, 4mg Nicoderm CQ(PL) patch: 7mg, 14mg, 21mg Nicorette(PL) gum: 2mg, 4mg Nicotine (multiple generic names) (PL) gum: 2mg, 4mg lozenge: 2mg, 4mg patch: 7mg, 14mg, 24mg

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* For plans that have a waiver of cost share for preventive care, PPACA’s requirement to waive cost share for contraceptive medications and devices will apply on plan or policy years on and after August 1, 2012. If you have a question about if or when this change is effective for your plan, please contact BCBSAZ.

 

12/9/16 Guidance to help you understand when your member cost share will be waived for preventive medications and devices. Nicotine System Kit (PL) patch: 7mg/14mg/21mg Nicotrol inhaler (PL) inhaler: 10mg

Nicotrol NS (PL) nasal Spray: 10mg/ml Zyban (PL) tablet: 150mg

VITAMIN D (PL)

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* For plans that have a waiver of cost share for preventive care, PPACA’s requirement to waive cost share for contraceptive medications and devices will apply on plan or policy years on and after August 1, 2012. If you have a question about if or when this change is effective for your plan, please contact BCBSAZ.

 

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