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- Antiretroviral therapy for preexposure prevention (PrEP) of human immunodeficiency virus (HIV) infection in people who are at an increased risk.
| - Emtricitabine-tenofovir disoproxil fumarate 200 mg- 300 mg (generic of brand name, Truvada)
- Descovy 25 mg-200 mg
- Apretude
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- Aspirin to help prevent (1) illness and death from preeclampsia in persons who are at least 12 years old, after 12 weeks of pregnancy.
| - Pregnancy diagnosis code required for coverage
- Aspirin chewable tablet 81 mg (OTC)
- Aspirin enteric coated tablet 81 mg (OTC)
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- Bowel preparation medications for clearing out the bowel before colonoscopy procedures for adults between 45 and 75 years of age. Colonoscopies screen for colon and rectal cancers.
| - Generic polyethylene glycol-electrolyte lavage solution (e.g., Gavilyte-G, Golytely, Nulytely, PEG-3350 and electrolytes)
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- Breast cancer prevention medications for women 35 years and older, who are at an increased risk.
| - Anastrozole tablet 1 mg
- Exemestane tablet 25 mg
- Raloxifene HCl tablet 60 mg
- Tamoxifen citrate tablet – 10 mg, 20 mg
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- Contraceptives are covered for women to prevent pregnancy, including those who identify as a gender that differs from the member’s sex assigned at birth.
| - Barrier methods
- Condoms – female and male
- Injectables
- Intrauterine devices
- Oral contraception
- Spermicides
- Subdermal rods
- Transdermal patches
- Vaginal pH modulators
- Vaginal rings
- Vaginal sponge
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- Emergency contraceptives to prevent pregnancy when taken after unprotected sex.
| - Ella
- Levonorgestrel 1.5 mg (e.g., MyWay) (generic of brand name, Plan B)
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- Fluoride supplements to help prevent cavities (dental caries) in children 5 years or younger whosewater is low in fluoride.
| - Sodium fluoride chewable tablets – 0.25 mg, 0.5 mg, 1 mg
- Sodium fluoride solution 0.5 mg/mL
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- Folic acid supplements to help prevent birth defects in women 55 yearsor younger who are planning to become pregnant or can become pregnant.
| - Folic acid capsules 0.8 mg (800 mcg) (OTC)
- Folic acid tablets 0.4 mg (400 mcg) (OTC)
- Folic acid tablets 0.8 mg (800 mcg) (OTC)
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- Statins to help prevent serious heart and blood vessel problems (cardiovascular disease) in adults between 45 and 75 years of ages who are at risk. Generic low to moderate intensity statins are provided at no-cost to eligible members.
| - Atorvastatin tablets – 10 mg,20 mg
- Lovastatin tablets – 20 mg, 40 mg
- Simvastatin – 10 mg, 20 mg, 40 mg
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- Tobacco cessation products to help adults who are not pregnant quit tobacco use, including smokingand chewing tobacco, to prevent health problems.
| - Bupropion HCl SR 150 mg (generic of brand name, Zyban)
- Generic nicotine replacement products – patch,gum, and lozenges
- Nicotine polacrilex gum– 2 mg and 4 mg
- Nicotine polacrilex lozenge – 2 mg and 4 mg
- Nicotine transdermal patch – 7 mg, 14 mg and 21 mg
- Varenicline tartrate
- Varenicline tabletsstarter pack (0.5mg x 11 tablets, 1 mg x 42 tablets)
- Varenicline tartrate tablets – 0.5 mg, 1 mg
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