Medications to promote better health as recommended under the ACA

This brochure version is for internal use only.

2023 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue Focus
Section 5(f). Prescription Drug Benefits

Benefits Description
Medications to promote better health as recommended under the Patient Protection and Affordable Care Act (the “Affordable Care Act”), limited to:

Iron supplements for children from age 6 months through 12 months
Oral fluoride supplements for children from age 6 months through 5 years
Folic acid supplements, 0.4 mg to 0.8 mg, for individuals capable of pregnancy
Low-dose aspirin (81 mg per day) for pregnant members at risk for preeclampsia
Aspirin for men age 45 through 79 and women age 50 through 79
Generic cholesterol-lowering statin drugs

Notes:

Benefits are not available for acetaminophen, ibuprofen, naproxen, etc.
Benefits for the medications listed above are subject to the dispensing limitations described on pages 91-92 and are limited to recommended prescribed limits.
To receive benefits, you must use a Preferred retail pharmacy and present a written prescription from your physician to the pharmacist.
A complete list of USPSTF-recommended preventive care services is available online at: www.healthcare.gov/preventive-care-benefits. See pages 41-45 and 75 in Section 5(a) and 5(c) for information about other covered preventive care services.
See page 98 for our coverage of smoking and tobacco cessation medications.

You Pay
Preferred retail and overseas retail pharmacy: Nothing (no deductible)

Non-preferred retail pharmacy: You pay all charges

Note: See Section 5(i), page 108, for information on how to file claims for overseas services.