Prescription Drugs Covered by the Prescription Drug Plan
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Drug
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Coverage Status
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Allergy Serums (oral immunotherapy drugs)
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Covered but requires prior authorization
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Aspirin
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Covered — generic aspirin (81mg only) is fully covered 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
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Breast Cancer Drugs
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Covered — generic anastrozole, exemestane, raloxifene, and tamoxifen are fully covered as part of a treatment therapy for women at risk for breast cancer and/or diagnosed with breast cancer for age 35 or older
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Contraceptives
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Covered — generic prescription contraceptives are fully covered, 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, while the brand-name version of the contraceptive would be covered according to the provisions for other brand-name medications (see chart under "What's Covered and Not Covered").
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Diabetic Supplies (includes certain glucose monitors, insulin pumps and related pump supplies)*
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Covered — except alcohol wipes
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Diet Medications (anorexiants and anti-obesity)
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Covered but requires prior authorization
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Fluoride Supplements
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Covered — generic fluoride supplements are fully covered for children age 5 or younger
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Infertility Drugs (exclusive of treatment)
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Covered up to a $10,000 lifetime maximum (combined Retail Pharmacy Benefit and Maintenance Choice® program) per person
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Legend Vitamins
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Covered
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Male Impotency Drugs
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Covered at 8 units per 30 days (24 units per 90 days through Maintenance Choice®).
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Prescription Tobacco Cessation Products
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Covered
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Proton Pump Inhibitors (PPIs) (such as Prilosec, Tagamet, and Nexium)
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Covered subject to preauthorization, as described under "Coverage for Proton Pump Inhibitors"
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Respiratory Therapy Supplies
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Covered — except nebulizers.
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Solaraze (Diclofenac sodium gel 3%)
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Covered but requires prior authorization.
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Solodyn
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Covered but requires prior authorization.
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* 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).