Health Care Reform (ACA) preventive health drugs
What are preventive health drugs?
Preventive health drugs are select drugs required to be covered at no cost to you in non-grandfathered Commercial plans. Preventive health drugs are determined based on evidence-based recommendations by the United States Preventive Services Task Force (USPSTF) with a rating of “A” or “B.”
For coverage of the preventive health drugs at no cost, the preventive health drugs must be prescribed by a healthcare provider and obtained from a Blue Shield of California participating pharmacy. You must also meet the specific coverage criteria listed below and have a pharmacy benefit with Blue Shield.
Eligible preventive health drugs require a valid prescription, including over-the-counter (OTC) products, to be covered under the pharmacy benefit. Other requirements may apply; please refer to your plan enrollment materials for complete benefit coverage information.
Talk with your doctor about which medication may be right for you. If your doctor feels a certain medication on this list isn’t right for you, ask your doctor to call us. We will work together to look for other medications that may be available at no cost to you.
Please call the phone number listed on your Blue Shield member ID card for any questions about preventive health drugs. This is not a prescription drug benefit or prescription drug coverage under Medicare Part B or Part D. Please see your plan documents to verify prescription drug benefits or coverage, as applicable.
The following list of preventive health drugs is available to download as a PDF:
Preventive health drugs list, English (PDF, 38 KB) | Spanish (PDF, 64 KB)
| Preventive drug and indication | Drug name (strengths) | Coverage criteria |
|---|---|---|
| Antiretroviral therapy – For pre-exposure prophylaxis (PrEP) in persons who are at high risk of HIV acquisition | emtricitabine 200mg/tenofovir 300mg (generic Truvada) Descovy 200mg/25mg Apretude |
Confirmation of use of PrEP required for use for all drugs listed Apretude covered under the medical benefit |
| Aspirin – To prevent preeclampsia for pregnant persons at high risk | aspirin 81mg | Persons that are currently pregnant |
| Bowel preparation products – To clear the colon prior to a colonoscopy screening | Gavilyte Peg-3350 solution Trilyte sodium sulfate-potassium sulfate-magnesium sulfate (generic Suprep) |
Ages 45 to 75 |
| Breast cancer prevention drugs – For women at high risk of developing breast cancer | anastrozole raloxifene tamoxifen |
Gender: female |
| Fluoride – Supplementation in children | fluoride (various strengths) | Ages 6 months to < 5 |
| Folic acid – Supplementation for persons planning to or who could become pregnant | folic acid 0.4mg, 0.8mg | Persons planning to or who could become pregnant |
| Statins – For the primary prevention of cardiovascular disease in intermediate or high-risk adults | atorvastatin 10mg, 20mg, simvastatin 5mg, 10mg, 20mg, 40mg |
Ages 40 to 75 Current use of a prescription drug that treats high cholesterol, diabetes, high blood pressure, or smoking cessation |
| Tobacco cessation drugs – Drug interventions for those who use tobacco products and desire to quit | bupropion hcl (generic Zyban) nicotine gum nicotine lozenges nicotine patches Nicotrol inhaler Nicotrol nasal spray varenicline (generic Chantix) |
Page last updated: 09/09/2024
