Preventive Pharmacy Benefits

The Affordable Care Act (ACA) provides in-network preventive benefits with no cost sharing. Preventive services are based on government recommendations. Check your member guide for more information specific to your preventive benefits.

If you require a medication, i.e. an oral contraceptive, that is not currently provided at a zero dollar cost share, an exception process does exist. More information about this process an be found at www.bluecrossnc.com/umdrug.

See below for the current list of drugs available under this benefit:

View the 2023 ACA Preventive Drug List for Individual Under 65 members and Group members on the Enhanced, Essential and NetResults formularies
View the 2022 ACA Preventive Drug List for Individual Under 65 members and Group members on the Enhanced, Essential and NetResults formularies

Preventive drugs¹ are covered under all prescription drug plans. However, some plans with Health Savings Accounts (HSA)² provide additional preventive coverage of drugs for certain chronic conditions.

The HSA preventive benefit enhancement is available on specific high-deductible health plans. This benefit waives the deductible for preventive drugs for certain chronic conditions.

See below for the current list of drugs available under this benefit:

View the 2023 HSA Preventive Drug List for Individual Under 65 members and Fully Insured Group members who have an HSA
- ASO groups have the option to elect this benefit
View the 2022 HSA Preventive Drug List for Individual Under 65 members and Fully Insured Group members who have an HSA
- ASO groups have the option to elect this benefit

The drug lists on this page are subject to change and will be updated on a periodic basis.

Learn more about other preventive care services.

¹Preventive drugs are considered to be used for preventive purposes if they are being prescribed primarily (1) to prevent the symptomatic onset of a condition in a person who has developed risk factors for a disease that has not yet become clinically apparent or (2) to prevent recurrence of a disease or condition from which the patient has recovered. A drug is not considered preventive if it is being prescribed to treat an existing symptomatic illness, injury or condition.

²Having a Health Savings Account (HSA) is an option groups can select for their employees. Please be sure to check your member guide to see if your group selected this benefit or call the customer service number listed on the back of your member ID card to verify benefit eligibility.