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Prescription Drugs Covered by the Prescription Drug Plan
Drug
Coverage Status
Allergy Serums (oral immunotherapy drugs)
Covered but requires prior authorization
Aspirin
Covered — generic aspirin (81mg only) is fully covered without a deductible as prevention medication
1) after 12 weeks of gestation in women who are at high risk for preeclampsia (Age limit: 12 or older, quantity limit: 100 units per fill);
2) for primary prevention of cardiovascular disease and colorectal cancer (Age limit: 50 to 59 years, quantity limit: 100 units per fill)
OTC products require prescription
Breast Cancer Drugs
Covered — generic anastrozole, exemestane, raloxifene, and tamoxifen are fully covered without a deductible as part of a treatment therapy for women at risk for breast cancer and/or diagnosed with breast cancer for age 35 or older
Contraceptives
Covered — generic prescription contraceptives are fully covered without a deductible, as are brand-name prescription contraceptives for which a generic is not available, such as Lo Loestrin® 24 Fe.
Please Note: If a generic prescription becomes available for a brand-name contraceptive, the generic form of the contraceptive will be fully covered without a deductible, while the brand-name version of the contraceptive would be covered according to the provisions for other brand-name medications (see chart under "How Prescription Drug Benefits Are Paid Under the Medical Plan").
Diabetic Supplies (includes certain glucose monitors, insulin pumps and related pump supplies)*
Covered - except alcohol wipes
Diet Medications (anorexiants and anti-obesity)
Covered but requires prior authorization
Fluoride Supplements
Covered — generic fluoride supplements are fully covered without a deductible for children age 5 or younger
Infertility Drugs (exclusive of treatment)
Covered up to a $10,000 lifetime maximum (combined Retail Pharmacy Benefit and Maintenance Choice® program) per person
Legend Vitamins
Covered
Male Impotency Drugs
Covered at 8 units per 30 days (24 units per 90 days through Maintenance Choice®).
Prescription Tobacco Cessation Products
Covered
Proton Pump Inhibitors (PPIs) (such as Prilosec, Tagamet, and Nexium)
Covered subject to preauthorization, as described under "Coverage for Proton Pump Inhibitors"
Respiratory Therapy Supplies
Covered — except nebulizers.
Solaraze (Diclofenac sodium gel 3%)
Covered but requires prior authorization.
Solodyn
Covered but requires prior authorization.
* Some glucose monitors and insulin pumps are available under the Medical Plan. For information on which insulin pumps are covered under the Medical and/or Prescription Drug Plan, please contact the appropriate provider (Aetna/Cigna and/or CVS Caremark)