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 participating pharmacy. You must also meet the specific coverage criteria listed below and have a pharmacy benefit with Blue Shield of California.

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; 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 customer service phone number listed on your Blue Shield member ID card for any questions about preventative health drugs.

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
Confirmation of use of PrEP required for use for all drugs listed
Apretude is covered under the medical benefit
Aspirin – To prevent heart disease and colorectal cancer aspirin 81mg Ages 50 to 59
Aspirin – To prevent preeclampsia for pregnant women at high risk aspirin 81mg Gender: female
childbearing age
Bowel preparation products – To clear the colon prior to a colonoscopy screening Suprep
Peg-3350 solution
Ages 45 to 75
Breast cancer prevention drugs – For women at high risk of developing breast cancer anastrozole
Gender: female
Fluoride – Supplementation in children fluoride (various strength) Ages 6 months to 5
Folic acid – Supplementation for women of childbearing age folic acid 0.4mg, 0.8mg Gender: female
childbearing age
Low to moderate dose 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 (Zyban)
nicotine gum
nicotine lozenges
nicotine patches
nicotrol inhaler
nicotrol nasal spray

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Last updated: December 2021

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