Myahpcare.com

For our members
Preventive Care Medications
Traditional Prescription Drug List (PDL)1,2,3
$0 Cost-share Medications & Products
U.S. Preventive Services Task Force A & B Recommendation
Medications and Supplements
These medications and supplements will be covered at $0 cost-share when:
 Prescribed by a health care professional  Age and/or gender appropriate  Filled at a network pharmacy Most medications are available over-the-counter (OTC) except for prescription fluoride. All brands are covered by the pharmacy benefit.  Aspirin - 81, 162 & 325 mg Prevent cardiovascular disease Folic acid 400 & 800 mcg Prevent birth defects Iron liquid supplement Children age 0-1 year Prevent anemia due to iron deficiency Vitamin D - 400 & 1,000 units Fall risk prevention Fluoride tablets, solution Prevent dental cavities if water Children age 0-6 years (not toothpaste, rinses) source is deficient in fluoride Over-the-Counter (OTC) Contraceptives for Women
These contraceptives are available over-the-counter (OTC) and will be covered at $0 cost-share when:
 Prescribed by a health care professional  Filled at a network pharmacyMale contraceptives are not covered under the Patient Protection and Affordable Care Act (PPACA).
Contraceptive films Contraceptive foams Contraceptive gels Emergency contraceptives (ella, generic for Plan B, generic for Plan B One-Step) Prescription Hormonal Contraceptives
Brand Hormonal Contraceptives
Natazia
Generic Hormonal Contraceptives
Altavera, Chateal, Kurvelo, Levonorgestrel/Ethinyl Estradiol, Levora-28, Marlissa, Portia (generic Nordette)
Alyacen 1/35, Cyclafem 1/35, Dasetta 1/35, Necon 1/35, Nortrel 1/35, Pirmella (generic Ortho-Novum 1/35)
Alyacen, Cyclafem, Dasetta, Necon, Nortrel, Pirmella (generic Ortho-Novum 7/7/7)
Amethia, Camrese, Daysee (generic Seasonique)
Amethia Lo, Camrese Lo, Levonorgestrel/Ethinyl Estradiol (generic LoSeasonique)
Amethyst (generic Lybrel)
Apri, Emoquette, Enskyce, Desogestrel/Ethinyl Estradiol, Reclipsen, Solia (generic Desogen, Ortho-Cept)
Aranelle, Leena (generic Tri-Norinyl)
Aubra, Aviane, Falmina, Lessina, Levonorgestrel/Ethinyl Estradiol, Lutera, Orsythia, Sronyx (generic Alesse)
Azurette, Kariva, Pimtrea, Viorele (generic Mircette)
Balziva, Briellyn, Gildagia, Philith, Vyfemla, Zenchent (generic Ovcon-35)
Camila, Errin, Heather, Jencycla, Jolivette, Lyza, Nora-BE, Norethindrone (generic Micronor, Nor-Q-D)
Caziant, Cesia, Velivet (generic Cyclessa)
Cryselle, Elinest, Low-Ogestrel, Norgestrel/Ethinyl Estradiol, Ogestrel (generic Lo/Ovral, Ovral)
Drospirenone/Ethinyl Estradiol, Ocella, Syeda, Zarah (generic Yasmin)
Enpresse, Levonest, Myzilra, Trivora-28 (generic Triphasil)
Estarylla, Mononessa, Mono-Linyah, Norgestimate/Ethinyl Estradiol, Previfem, Sprintec (generic Ortho-Cyclen)
Gianvi, Loryna, Vestura (generic Yaz)
Gildess FE, Junel FE, Larin FE, Microgestin FE (generic Loestrin FE)
Gildess, Junel, Larin, Microgestin (generic Loestrin)
Introvale, Jolessa, Levonorgestrel/Ethinyl Estradiol, Quasense (generic Seasonale)
Kelnor, Zovia 1/35E (generic Demulen 1/35)
LoMedia 24 FE (generic Loestrin 24 FE)
Medroxyprogesterone Acetate (generic Depo-Provera)
Necon 1/50 (generic Norinyl 1/50)
Necon 0.5/35, Nortrel 0.5/35, Wera (generic Brevicon, Modicon)
Necon 10/11 (generic Ortho-Novum 10/11)
Norgestimate/Ethinyl Estradiol, Tri-Estarylla, Tri-Linyah, Trinessa, Tri-Previfem, Tri-Sprintec (generic Ortho Tri-Cyclen)
Norethindrone/Ethinyl Estradiol, Wymzya FE, Zenchent FE, Zeosa (generic Femcon FE)
Tilia FE, Tri-Legest FE (generic Estrostep FE)
Xulane (generic Ortho Evra)
Zovia 1/50E (generic Demulen 1/50)
Prescription Emergency Contraceptives
Brand Emergency Contraceptives
ella
Plan B One-Step
Generic Emergency Contraceptives
Levonorestrel, Next Choice (generic Plan B)
My Way, Next Choice One Dose (generic Plan B One-Step)
Prescription Diaphragms
1. Please note this list is subject to change.
2. Always refer to your benefit plan materials to determine your coverage for medications and cost-share. Some medications listed on the PDL may not be covered under your specific benefit. Where differences are noted, the benefit plan documents will govern.
3. All branded medications are trademarks or registered trademarks of their respective owners.
Health Care Reform
Pharmacy Benefit Preventive Care Medications Coverage
Frequently Asked Questions Under the health reform law, health plans must cover Will this drug list change?
U.S. Preventive Services Task Force A & B Recommendation Drug lists can and do change, so it's always good to check. medications and FDA-approved prescription and Over- You can learn the cost of all products and view no-cost The-Counter (OTC) contraceptives for women at 100 percent without charging a copayment, coinsurance or deductible when:  Logging in to www.uhcsr.com, and log in
 Prescribed by a health care professional "To My Account."  Age- and gender-appropriate  Calling the number on your health ID card.  Filled at a network pharmacy Are all birth control products available
To comply with this new law which was clarified at no cost to me?
further by the U.S. Dept. of Labor on February 20, 2013, we No, only the products on the list applicable to your plan will offer this list of no-cost Preventive Care Medications. be no cost under the pharmacy benefit.5 The health reform When are Preventive Care Medications available?
law al ows plans to use reasonable medical management to This list of Preventive Care Medications is available to you decide which contraceptive products are provided at no for $0 cost-share at network pharmacies now.4 Please note, in order to obtain coverage for U.S. Preventive
If you choose a no-cost product from the list applicable to Services Task Force A & B Recommendation medications
your plan, your cost at the pharmacy wil be $0. If you choose and OTC contraceptives, you must have a prescription
a covered birth control product that is not on the list, a from a health care professional and the product(s) must be copay or co-insurance may be required. And this cost will age-and gender-appropriate. apply to your deductible if you have one. What if I have a high-deductible or
Which Preventive Care Medications are
consumer-driven health (CDH) plan?
available at no cost?
A list of Preventive Care Medications can be found on
The same no-cost options on the list applicable to your plan page 1 and 2 of this document so you can discuss them with
will be available to you if you are in one of these plans. If your doctor. You can also login to www.uhcsr.com, and log
you fill a prescription for covered birth control products not in "To My Account," or call the number on your health on your plan's no-cost drug list, you will need to pay the full ID card to confirm the most current list of Preventive Care cost, until your pharmacy plan deductible is reached. Medications for your plan. 4. The cost for U.S. Preventive Services Task Force A & B Recommendation medications and OTC contraceptives on this list could be reimbursed back to Feb. 20, 2013 when the U.S. Dept. of Labor FAQ guidance was issued. However, they become available at network retail pharmacies at $0 cost-share on November 1, 2013.
5. When informed, an issuer must accommodate any member when one of the zero cost contraceptives listed on PDL Tier 1 may be medically inappropriate as determined by the member's health care provider and waive the otherwise applicable cost-sharing for a contraceptive not represented on PDL Tier 1.
Are the no-cost Preventive Care Medications
What if my plan has a religious exemption for
available at both retail and mail pharmacies?
Preventive Care Medications are available at both network Some plans may not have coverage for contraceptives if retail pharmacies and the mail order pharmacy for plans with your employer qualifies for a religious exemption. However, a mail order benefit. you will still have coverage without cost-share of the U.S. Preventive Services Task Force A & B Recommendation What if the health care reform law requirements
medications listed on the Preventive Care Medications list for Preventive Care Medication coverage change?
(such as aspirin and vitamin D).
If the law requiring plans to provide Preventive Care Medications at no cost changes, information on how your costs may be impacted will be available to you by:
 Logging in to www.uhcsr.com, and log in "To My
 Calling the number on your health ID card. Still have questions?
Login to www.uhcsr.com, and log in "To My Account,"
or call the number on your health ID card.
M51372-DD Student Resources 6/14 2014 United HealthCare Services, Inc.

Source: https://myahpcare.com/wp-content/uploads/2014/05/UHC_Birth_Control_14_15.pdf