EmblemHealth City of New York Affordable Care Act Coverage Guidelines

Transcription

1 EmblemHealth City of New York Affordable Care Act Coverage Guidelines Starting July 1, 2016, the medications listed below will be covered for City of New York members with Medical Coverage. You will pay a $0 copay for these medications through EmblemHealth. This is an Affordable Care Act (ACA) mandate. To get this coverage, you must get a prescription from your doctor in our network, even for over-the-counter medications. Aspirin: All genders, through age 59, can get 325mg or less for the prevention of cardiovascular events and preeclampsia. Fluoride: Generic only, for children age six months five years old. A generic has the same strength, dose, and effectiveness as a brand name drug. This applies to over-the-counter and prescription drugs. Folic Acid: Generic only, for all members through age 50. This applies to over-the-counter and prescription drugs. Immunizations: Covers all recommendations made by the Advisory Committee on Immunization Practices (ACIP). You will only be able to get vaccination at a $0 copay if the member is the age appropriate for the vaccine. Some vaccines may be covered through your medical plan. Contraceptives: All contraceptives, or birth control, are covered until age 50. These are permissible as written by your doctor: o All approved prescriptions and over-the-counter products. o Single source brands (drugs that do not have a generic version). o Generic drugs and Multisource brands (drugs that are made by more than one company). This is called Dispense-As-Written and is covered for codes 1, 4, 5, and 8. Implants and IUDs are covered under your medical plan. Smoking Cessation: These prescription and over-the-counter products for members age 18 and older are approved to help you quit smoking. Both brand name and generic drugs apply, but after 180 days of therapy (in one year), you will be charged the full prescription copay. Vitamin D: Generic prescription and over-the-counter drugs only, for members age 65 and older. Bowel Prep products: Generic prescription and over-the-counter drugs only, for members age 50 to 75. There is a limit of two prescriptions per year (365 days), after which you will be charged your full prescription copay. Primary prevention of breast cancer: These drugs are reviewed when a member or doctor requests an exception. o Raloxifene (the generic version of brand name Evista) is only covered for the primary prevention of Breast Cancer in women age 35 and older. Your doctor will need to provide the diagnosis to receive coverage at no cost. o All other drugs from Primary Prevention, or the reduction, of breast cancer are covered through New York City s PICA Program not through EmblemHealth. (continued)

2 List of Covered ACA Drugs in Alphabetical Order: ACTHIB ADACEL ADULT LOW DOSE ASPIRIN AFLURIA AFLURIA QUAD AFTERA ALOPHEN PILLS ALTAVERA ALYACEN AMETHIA AMETHIA LO AMETHYST APRI ARANELLE ASHLYNA ASPIR 81 ASPIRIN ASPIRIN E.C. LOW DOSE ASPIRIN ENTERIC COATED ASPIRIN ASPIR-LOW ASPIR-TRIN AUBRA AVIANE AZURETTE B COMPLETE B COMPLEX VITAMIN B COMPLEX B-COMPLEX B-BALANCED BALANCE B BALANCE-B BALANCED B-COMPLEX BALZIVA TICE BCG B COMPLEX W/C B COMPLEX W-VITAMIN C BEKYREE BEXSERO BEYAZ BIOTHRAX BISACODYL BISA-LAX BLISOVI 24 FE BLISOVI FE BOOSTRIX BREVICON BRIELLYN BUFFERIN BUPROBAN BUPROPION SR CALCARB 600 WITH VITAMIN D CALCIUM + D3 CALCIUM + VITAMIN D OYSTER SHELL CALCIUM W/VIT D CALCIUM CALCIUM CARBONATE W/VITAMIN D CALCIUM CARBONATE CALCIUM CITRATE W/VITAMIN D CALCIUM CITRATE PLUS CALVITE P&D CAMILA CAMRESE CAMRESE LO CAYA CONTOURED CAZIANT CERVARIX CHANTIX CHATEAL CHILDREN'S ASPIRIN FERROUS SULFATE CHILDREN'S IRON CITRATE OF MAGNESIA CITROMA CITRUS CALCIUM WITH VIT D PRENAVITE CLEARLAX COMPLEX B-100 COMVAX CONCEPTROL CRYSELLE BUFFERED ASPIRIN CHILDREN'S VITAMIN D MAGNESIUM CITRATE FOLIC ACID GENTLE LAXATIVE MILK OF MAGNESIA NICOTINE NICOTINE GUM NTS PHOSPHATE LAXATIVE PRENATAL MULTI + DHA PRENATAL PURELAX STRESS FORMULA SUPER B-COMPLEX W/VITAMIN C VITAMIN D3 WOMEN'S GENTLE LAXATIVE CYCLAFEM CYCLESSA CYRED DAILY PRENATAL DAPTACEL DASETTA DAYSEE DEBLITANE DELTA D3 DELYLA DESOGEN DESOGESTREL-ETHINYL ESTRADIOL DESOGESTR-ETH ESTRAD ETH ESTRA DIALYVITE 800 DIPHTHERIA-TETANUS TOXOIDS-PED DROSPIRENONE-ETH ESTRA- LEVOMEF DROSPIRENONE-ETHINYL ESTRADIOL DUCODYL D-VI-SOL D-VITA ECONTRA EZ ECOTRIN ECPIRIN ELINEST ELLA EMOQUETTE ENGERIX-B

3 ENPRESSE ENSKYCE WOMEN'S LAXATIVE LAXATIVE PRENATAL VITAMIN WOMAN'S LAXATIVE ERRIN ESTARYLLA ESTROSTEP FE ETHYNODIOL-ETHINYL ESTRADIOL EZ FLU (FLUZON QUAD PED) SINGLE USE EZ FLU EZ FLU (FLUVIRIN) EZ FLU (AFLURIA) EZ FLU (FLUVIRIN) FALLBACK SOLO FALMINA FARBEE W-C FC2 FEMALE CONDOM FEMCAP FEMCON FE FEMYNOR FER-IRON FLUAD FLUARIX FLUARIX QUAD FLUBLOK FLUBLOK FLUBLOK FLUBLOK FLUCELVAX FLUCELVAX QUAD FLULAVAL FLULAVAL QUAD FLUOR-A-DAY FLUORIDE FLUORITAB FLUVIRIN FLUZONE FLUZONE HIGH-DOSE FLUZONE INTRADERMAL FLUZONE INTRADERM QUAD FLUZONE INTRADERM QUAD FLUZONE PEDI FLUZONE QUAD FLUZONE QUAD FLUZONE QUAD FLUZONE QUAD PEDI FLUZONE QUAD PEDI FLUZONE QUAD PEDI FOLTABS 800 FULL SPECTRUM B GARDASIL 9 GARDASIL GAVILAX GAVILYTE-C GAVILYTE-G GAVILYTE-H AND BISACODYL GAVILYTE-N GENERESS FE GENTLELAX GIANVI GILDAGIA GILDESS GILDESS 24 FE GILDESS FE GLYCOLAX LITE COAT ASPIRIN GYNOL II HAVRIX HEALTHYLAX HEATHER HIBERIX VIT B COMP W/C IMOVAX RABIES VACCINE IMPLANON INFANRIX INTROVALE IPOL IXIARO JENCYCLA JOLESSA JOLIVETTE JULEBER JUNEL JUNEL FE KAITLIB FE KARIVA KELNOR 1-35 KIMIDESS KINRIX KOBEE KPN KURVELO KYLEENA LARIN LARIN FE LARISSIA LAXA CLEAR FEMININE LAXATIVE LAYOLIS FE LEENA LESSINA LEVONEST LEVONORG-ETH ESTRAD ETH ESTRAD LEVONORGESTREL-ETH ESTRADIOL LEVONORGESTREL LEVORA LILETTA LIQUID CALCIUM +D LO LOESTRIN FE LO MINASTRIN FE LOESTRIN LOESTRIN FE LOMEDIA 24 FE LORYNA LOSEASONIQUE LOW-OGESTREL LUDENT FLUORIDE LUTERA LYZA MARLISSA MENACTRA MENHIBRIX MENOMUNE-A-C-Y-W-135 MENVEO A-C-Y-W-135-DIP MICROGESTIN MICROGESTIN 24 FE MICROGESTIN FE MINASTRIN 24 FE MINIPRIN MIRALAX MIRCETTE MIRENA M-M-R II VACCINE W/DILUENT MODICON MONO-LINYAH MONONESSA

4 MULTIVITAMIN WITH FLUORIDE MULTIVITAMIN W/FLUORIDE & IRON MVC-FLUORIDE MY WAY MYZILRA NATAZIA NECON NEXPLANON NEXT CHOICE ONE DOSE NICODERM CQ NICORELIEF NICORETTE NICOTROL NICOTROL NS NIKKI NORA-BE NORETHIN-ETH ESTRA FERROUS FUM NORETHINDRONE-ETHIN ESTRADIOL NORETHINDRONE ACETATE NORGESTIMATE-ETHINYL ESTRADIOL NORGESTREL-ETHINY ESTRA NORINYL NORLYROC NOR-Q-D NORTREL NUVARING OCELLA OGESTREL OPCICON ONE-STEP OPTION 2 ORAL SALINE LAXATIVE ORSYTHIA ORTHO-DIAPHRAGM ORTHO EVRA ORTHO MICRONOR ORTHO TRI-CYCLEN ORTHO TRI-CYCLEN LO ORTHO-CEPT ORTHO-CYCLEN ORTHO-NOVUM OVCON OYSCO D OYSTER CALCIUM W/VITAMIN D OYSTERCAL-D PARAGARD T 380-A P-D NATAL PLUS WITH FOLIC ACID PEDIARIX PEDVAXHIB PEG 3350-ELECTROLYTE PEG PEG-3350 WITH FLAVOR PACKS PEG-PREP PENTACEL ACTHIB COMPONENT PENTACEL PERRY PRENATAL TABLET PHILITH PIMTREA PIRMELLA PLAN B ONE-STEP PNEUMOVAX 23 POLYETHYLENE GLYCOL VITA DROPS W/IRON POLY-VITAMIN W/IRON POLY-VITAMIN WITH FLUORIDE PORTIA POTEN B-150 POWDERLAX PRENATAL COMPLETE PRENATAL FORMULA PREVIFEM PREVNAR 13 PROQUAD STOP SMOKING AID LAXATIVE PEG 3350 QUADRACEL DTAP-IPV QUARTETTE QUASENSE QUIT 2 QUIT 4 TRI-BUFFERED ASPIRIN HI-CAL RABAVERT RAJANI REACT RECLIPSEN RECOMBIVAX HB RENA-VITE RISACAL-D ROTARIX ROTATEQ SAFYRAL SEASONIQUE SETLAKIN SHAROBEL SINGLE USE EZ FLU SINGLE USE EZ FLU SKYLA SMOOTHLAX SODIUM FLUORIDE SPRINTEC SRONYX STRESS FORMULA VITAMIN + IRON SUPER B MAXI COMPLEX SUPER B COMPLEX SUPER CALCIUM W/VITAMIN D SUPER QUINTS SUPERPLEX-T SYEDA TAKE ACTION TARINA FE TAYTULLA TENIVAC TETANUS DIPHTHERIA TOXOIDS TETANUS TOXOID TILIA FE TODAY CONTRACEPTIVE SPONGE TOTAL B WITH C TRI-ESTARYLLA TRI-LEGEST FE TRI-LINYAH TRI-LO-ESTARYLLA TRI-LO-MARZIA TRI-LO-SPRINTEC TRILYTE WITH FLAVOR PACKETS TRINESSA LO TRINESSA TRI-NORINYL TRIPLE-VITAMIN W-FLUORIDE TRI-VITAMIN WITH FLUORIDE TRI-PREVIFEM TRI-SPRINTEC TRI-VITAMIN WITH IRON-FLUORIDE TRIVORA TRUMENBA TWINRIX TYPHIM VI ULTRA B-100 COMPLEX VAQTA

5 VARIVAX VACCINE VARIZIG VAXCHORA VACCINE VCF VELIVET VESTURA VIENVA VIORELE VITAMINS A;C;D & FLUORIDE VITABEE W-C VITA B COMP W/C B-COMPLEX & C VITAMIN B-COMPLEX & C VITAMIN D VITAMIN D2 VITAMIN D-400 VIVOTIF BERNA VIVOTIF VYFEMLA WEE CARE WERA WIDE SEAL DIAPHRAGM WYMZYA FE XULANE YASMIN YAZ YF-VAX ZARAH ZENCHENT ZENCHENT FE ZEOSA ZOSTAVAX ZOVIA ZYBAN