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Microsoft word - 2013 preventive drug list 010113

2013 Preventive Drug List
For High-Deductible Health Plans Only

effective 1/1/13
If your High-Deductible Health Plan includes the Preventive Drug List option, you just pay a copay for preventive care medications instead of having to meet your plan’s deductible for certain prescription drugs. Prescription drugs on the Preventive Drug List will be covered as if you already met your deductible, so you are only responsible for paying the appropriate copay. This enhanced benefit to your High-Deductible Health Plan makes it easier for you to purchase the medications you and your family need to stay healthy today – and tomorrow. Medications on the Preventive Drug List help prevent, treat and manage several health concerns. Some of these conditions, if not prevented or managed, can lead to serious illnesses and complications. Following your doctor’s treatment plan, including taking prescribed medications as directed, can help you live a healthier life today, and avoid serious illness and high health care costs in the future. This list contains some of the most commonly prescribed preventive care drugs and is not all-inclusive. This list does not guarantee coverage for preventive care drugs that are not listed. This list is subject to change throughout the year. Check bcbst.com for the current list. To ensure coverage, check your Schedule of Benefits or call Member Services at 1-800-565-9140. Covered Generics
Preferred Covered Brands
Non-Preferred Covered Brands
(always your lowest copay)
(may have a reduced copay)
(always your highest copay)
Asthma and Other Respiratory Conditions
Conditions Related to Blood Clots
Arixtra QL
enoxaparin QL
Fragmin QL
fondaparinux QL
Lovenox QL
Pradaxa PA
Xarelto PA QL
Contraception
This list is subject to change throughout the year. Please call Customer Service at the phone number listed on your BlueCross BlueShield of Tennessee member ID card or visit our Web site at BCBST.com for the most up-to-date information. Covered Generics
Preferred Covered Brands
Non-Preferred Covered Brands
(always your lowest copay)
(may have a reduced copay)
(always your highest copay)
Contraception (cont.)
Diabetes
Humalog ST (pens & vials)
Diabetic Supplies
Bayer Contour/Breeze2 diabetic products* QL
alcohol preps and lancets QL
Roche Accu-Chek products* QL
BD insulin syringes QL
*Under your plan, this brand-name product is available at the lowest copay level. Emotional Health
Abilify PA
Fanapt PA
Geodon PA
Invega PA
Latuda PA
clozapine PA
Saphris PA
Seroquel PA
Seroquel XR PA
haloperidol PA
This list is subject to change throughout the year. Please call Customer Service at the phone number listed on your BlueCross BlueShield of Tennessee member ID card or visit our Web site at BCBST.com for the most up-to-date information. Covered Generics
Preferred Covered Brands
Non-Preferred Covered Brands
(always your lowest copay)
(may have a reduced copay)
(always your highest copay)
Emotional Health (cont.)
olanzapine PA
quetiapine PA
risperidone PA
thiothixene PA
ziprasidone PA
Hepatitis C
ribavirin PA
Incivek PA
Copegus PA
Pegasys PA
PegIntron PA
Victrelis PA
Rebetol PA
High Blood Pressure & Other Heart Conditions
This list is subject to change throughout the year. Please call Customer Service at the phone number listed on your BlueCross BlueShield of Tennessee member ID card or visit our Web site at BCBST.com for the most up-to-date information. Covered Generics
Preferred Covered Brands
Non-Preferred Covered Brands
(always your lowest copay)
(may have a reduced copay)
(always your highest copay)
High Blood Pressure & Other Heart Conditions (cont.)
High Cholesterol
Multiple Sclerosis
Osteoporosis (a bone disease)
This list is subject to change throughout the year. Please call Customer Service at the phone number listed on your BlueCross BlueShield of Tennessee member ID card or visit our Web site at BCBST.com for the most up-to-date information. Covered Generics
Preferred Covered Brands
Non-Preferred Covered Brands
(always your lowest copay)
(may have a reduced copay)
(always your highest copay)
Prenatal Care (Vitamins)
Seizure Conditions
Thyroid Modifiers
This list is subject to change throughout the year. Please call Customer Service at the phone number listed on your BlueCross BlueShield of Tennessee member ID card or visit our Web site at BCBST.com for the most up-to-date information.

Source: http://ajaxteammember.com/HR/Preventive%20Drug%20Listing.pdf

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