HEALTHCARE REFORM PREVENTIVE MEDICATIONS LIST NO COST-SHARE PREVENTIVE MEDICATIONS

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1 The Patient Protection and Affordable Care Act (PPACA), also know as HealthCare Reform, includes coverage for preventive health care services and certain medication with no out-of-pocket. The Department of Health and Human Services (HHS) has recognized several recommending bodies (e.g., United States Preventive Services Task Force [USPSTF], Advisory Committee on Immunization Practices [ACIP], Health Resources and Services Administration [HRSA]) who have identified several medication categories that fall within the preventive health mandate. Identified below are the medication categories that are eligible for coverage without patient copayment. The following products, prescription medications and specific over-the counter medications are available to our members with no cost-sharing (copay, coinsurance or deductible). A prescription is required to process for these products and medications to be covered under the at no cost. These medication s are subject to the terms of the Community Health Network Benefit Plan. Also identified are exclusions within the medication categories that would not be eligible for exemption of patient cost-sharing under the preventive health benefit. However, these excluded medications may still be covered under the standard pharmacy benefit based on client-specific plan design.the list of he categories of the medications covered is also available on InComm on the ProHealth page. References: U.S. Department of Health and Human Services. Recommended Preventive Services. Available online at recommendations.html. Accessed July 25, U.S. Department of Health and Human Services Health Resources and Services Administration. Women's Preventive Services: Required Health Plan Coverage Guidelines. Available online at Accessed July 25, 2012.

2 Aspirin The USPSTF recommends the use of aspirin for men age 45 years to 79 years when the potential benefit due to a reduction in myocardial infarctions outweighs the potential harm due to an increase in gastrointestinal hemorrhage. The USPSTF recommends the use of aspirin for women age 55 years to 79 years when the potential benefit of a reduction in ischemic strokes outweighs the potential harm of an increase in gastrointestinal hemorrhage. Fluoride Age limit >44 men and women Quantity Limit: 1 per day Prescription required for all products and medications to be covered Oral over-the-counter (OTC) aspirin products with prescription Generic only Prescription aspirin products non-oral aspirin products combination aspirin products aspirin strengths > 325 mg.** The USPSTF recommends that primary care clinicians prescribe oral fluoride supplementation at currently recommended doses to preschool children older than 6 months whose primary water source is deficient in fluoride Children ages 6 months to 6 years Prescription (generic single ingredient only) oral fluoride supplementation products. Exclude branded oral fluoride supplementation products/** Topical fluoride products (e.g., toothpaste, rinses, etc Folic Acid Supplementation The USPSTF recommends that all women planning or capable of pregnancy take a daily supplement containing 0.4 mg to 0.8mg (400µg to 800µg) of folic acid. Age limit <55 yrs. Quantity limit: 1 per day OTC products require prescription OTC folic acid supplementation products (with prescription), including prenatal vitamins containing folic acid, some generic prescription prenatal vitamins. Folic acid supplementation products and any product containing > 0.8mg or < 0.4mg of folic acid**

3 Iron Supplement The USPSTF recommends routine iron supplementation for asymptomatic children ages 6 months to 12 months who are at increased risk for iron deficiency anemia. Children ages 6 to 12 months Prescription required for all products and medications to be covered Prescription and OTC (with prescription) iron supplementation products. Generic products when available. Exclude intravenous iron products and bulk iron products** Vitamin D Supplement The USPSTF recommends that all community dwelling adults 65 years and older take a daily supplement of vitamin D to prevent falls. Age limit adults >64 yrs. OTC vitamin D supplementation products (single ingredient only with prescription) vitamin D supplementation products and combination products containing vitamin D** Tobacco Cessation The USPSTF recommends that clinicians ask all adults about tobacco use and provide tobacco cessation interventions for those who use tobacco products. Age limit >17 under care of provider for tobacco cessation. OTC products require prescription 2-cycles per year including all products. Prescription and OTC (with prescription) smoking cessation products (e.g., nicotine products, buproprion [generic only] Chantix)- see detail on CHN Prohealth smoking cessation program.

4 OTC female contraceptive products and prescription emergency contraceptive products are not considered maintenance medications; therefore these products are not eligible for 90-day supplies. Contraceptives OTC OTC female contraceptive products* (with prescription): Spermicides (e.g., vaginal gel/foam/film/ suppositories) Quantity limit of 12 units (or days supply for gel/foam) per month Exclude intravenous iron products and bulk iron products** Sponges - Quantity limit of 12 units per month Contraceptive Prescription Quantity limit of 1 tab per day applies to all products Monophasic, Biphasic, Triphasic, Extended Cycle generics only Four-phasic only brand product available within drug class (Natazia) Contraceptive Patch generic only; quantity limit of 3 patches per month Brand name products for monophasic, biphasic, triphasic and extended cycle* Contraceptive Ring only brand product available within drug class (Nuvaring); quantity limit of 1 ring per month Contraceptive Prescription Devices Quantity limit of 1 unit per year Diaphragms - Quantity limit of 1 unit per year Cervical Caps Quantity limit of 1 unit per year

5 OTC female contraceptive products and prescription emergency contraceptive products are not considered maintenance medications; therefore these products are not eligible for 90-day supplies. Contraceptives Emergency Quantity limit of 2 courses per year Emergency contraceptives* Generics only;- Quantity limit of 2 courses per year Branded products # ; Contraceptive Prescription Quantity limit of 1 tab per day applies to all products Monophasic, Biphasic, Triphasic, Extended Cycle generics only Four-phasic only brand product available within drug class (Natazia) Contraceptive Patch generic only; quantity limit of 3 patches per month Branded name products for monophasic, biphasic, triphasic and extended cycle* Contraceptive Ring only brand product available within drug class (Nuvaring); quantity limit of 1 ring per month Other Contraceptive Covered under Medical Benefit Injectables Contraceptives generics only; quantity limit of 1 injection per 90 days IUD Branded products # ;

6 Immunization: Vaccines ACIP Recommendations: The HHS recommends routine immunizations as determined by the ACIP, a federal entity comprised of immunization experts. Multiple childhood and adult immunizations are included in the recommendations. Covered under medical benefit Age and/or gender limits apply in accordance with the recommendations of the ACIP to the following vaccines: Single-entity and combination vaccinations for diphtheria, haemophilus influenzae type b*, hepatitis A, hepatitis B, herpes zoster*, human papillomavirus*, polio, influenza, measles, mumps, rubella, meningococcal infections, pertussis pneumococcal infections, rotavirus*, tetanus, varicella. Exclude vaccines not listed in the 2013 ACIP Immunization Schedules #. *Age and/or gender limits apply in accordance with the recommendations of the ACIP to the following vaccines: Haemophilus influenzae type b applies only to children < 6 years Herpes zoster applies only to adults > 60 years Human papillomavirus applies only to children and adults 9 years to 26 years of age Bowel Prep for Colon Rectal Cancer Screening The USPSTF recommends screening for colorectal cancer using fecal occult blood testing, sigmoidoscopy, or colonoscopy in adults beginning at age 50 years and continuing until age 75 years. Adults 50 years or older Quantity limit of 1 bowel preparation product per year applies Generic prescription bowel preparation agents Branded bowel preparation products Tamoxifen The USPSTF recommends that for women who are at increased risk for breast cancer and at low risk for adverse medication effects, clinicians should offer to prescribe riskreducing medications, such as tamoxifen or raloxifene. Women at increased risk of breast cancer Oral tamoxifen (generic only) at zero co-pay for prevention and treatment for women. Brand Tamoxifen and both brand and generic raloxifene