PPACA No Cost-Share Preventive Medications By drug category
Preventive medications are used to keep certain conditions from developing or from coming back.
Certain preventive medications are available at no cost-share to you Health care reform under the Patient Protection and Affordable Care Act (PPACA) requires plans to cover certain preventive medications and products at 100%, or no cost-share ($0), to you. 1 The U.S. Preventive Services Task Force and the Institute of Medicine provides guidance on which drug classes should be covered on this list. These recommendations are meant to help prevent disease, as well as meet women’s unique health care needs. Talk with your doctor to see if one of these medications may work for you. If your doctor feels a certain contraceptive product or quit smoking medication/product on this list isn’t right for you, ask your doctor to contact Cigna Healthcare SM . Together, we’ll look for other medications that may be available at no cost-share. About this drug list This is a list of the preventive prescription medications and over-the-counter (OTC) products available to you at no cost-share (copay, coinsurance and/or deductible). • For your plan to cover these medications at 100%, you’ll need to get a prescription from your doctor
– even for the OTC products , which are typically available without a prescription. • Medications are listed alphabetically by drug category. • Generic medications are listed in all lowercase letters and brand-name medications are listed in all capital letters. • This drug list is updated as the U.S. Preventive Services Task Force makes new recommendations. Log in to the myCigna ® App 2 or myCigna.com ® , or check your plan materials, to learn more about how your plan covers preventive medications. Religious exemptions to contraception coverage PPACA allows certain employers to not cover (or exclude) contraceptives from coverage based on their religious beliefs. For women with a Cigna Healthcare pharmacy plan through one of these employers, where the law requires, Cigna Healthcare will pay for contraceptives and/or certain medications at no cost. This coverage is private and confidential and isn’t administered, funded by or connected in any way, to the employer’s health coverage.
Offered by: Cigna Health and Life Insurance Company, Connecticut General Life Insurance Company, or their affiliates. 968433 d PPACA 03/24 © 2024 Cigna Healthcare.
PPACA No Cost-Share Preventive Medications This is a list of the preventive prescription medications and the over-the-counter (OTC) products available to you at no cost-share under PPACA. This drug list is updated as the U.S. Preventive Services Task Force makes new recommendations.
Aspirin Products Available to women who are at least 12 weeks pregnant and at high risk for pre-eclampsia. aspirin 81 mg Barrier Contraception AIMSCO CAYA CONTOURED FC2 FEMALE CONDOM FEMCAP gynol ii MALE CONDOM 3 TODAY CONTRACEPTIVE SPONGE VCF FILM, GEL WIDE SEAL DIAPHRAGM Bowel Prep Products for Colorectal Cancer Screenings Available to adults 45-75 years of age . alophen pills bisacodyl tablet clearlax CLENPIQ CORRECTOL DULCOLAX TABLET gavilax
Folic Acid Supplementation (Only for products containing 0.4 mg– 0.8 mg of folic acid) BRAINSTRONG PRENATAL classic prenatal FA-8 folic acid 0.4 mg, 0.8 mg, 400 mcg, 800 mcg tablet folitab 500 kpn tablet MINI PRENATAL ONE A DAY WOMEN’S PRENATAL DHA one daily prenatal ONE-A-DAY PRENATAL ONE-A-DAY PRENATAL-1 perry prenatal PRENATAL prenatal complete PRENATAL FORMULA-DHA PRENATAL GUMMIES PRENATAL MULTI PRENATAL MULTI-DHA prenatal multivitamin PRENATAL MULTIVITAMIN-DHA prenatal one daily PRENATAL VITAMIN PRENATAL PLUS-DHA prenatal vitamin PRENATAL VITAMIN + DHA prenatal vitamins SIMILAC PRENATAL STUART ONE ULTRA PRENATAL PLUS DHA Hormonal Contraception 5,6
peg-prep polyethylene glycol 3350 powderlax purelax smoothlax sodium sulfate-potassium sulfate- magnesium sulfate SUFLAVE SUTAB women’s gentle laxative women’s laxative Breast Cancer Prevention 4
anastrozole exemestane
raloxifene tamoxifen Cholesterol Related 5 Available to adults 40-75 years of age atorvastatin fluvastatin fluvastatin er lovastatin 20 mg, 40 mg tablet pitavastatin pravastatin rosuvastatin 5 mg, 10 mg tablet simvastatin 10 mg, 20 mg, 40 mg tablet Emergency Contraception
gavilyte-c gavilyte-g gavilyte-n gentle laxative ec tablet gentlelax healthylax laxaclear laxative ec 5 mg tablet laxative peg 3350 MIRALAX
after pill AFTERA curae econtra ez econtra one-step ELLA her style levonorgestrel my choice my way new day opcicon one-step option 2 TAKE ACTION
afirmelle altavera
alyacen amethia amethia lo amethyst apri
natura-lax NULYTELY peg 3350-electrolyte peg-3350 and electrolytes peg3350-sodium sulfate-sodium chloride-potassium chloride sodium ascorbate-ascorbic acid
aranelle ashlyna aubra
Generic medications are listed in all lowercase letters and brand-name medications are listed in all capital letters.
2
PPACA No Cost-Share Preventive Medications
Hormonal Contraception 5,6 (Cont.)
hailey hailey 24 fe hailey fe haloette heather iclevia incassia isibloom jaimiess jasmiel jencycla jolessa joyeaux juleber junel junel fe junel fe 24 kaitlib fe
microgestin 24 fe microgestin fe mili mono-linyah necon NEXPLANON nikki nora-be norelgestromin-ethinyl estradiol norethindrone norethindrone-ethinyl estradiol norethindrone-ethinyl estradiol-fe norgestimate-ethinyl estradiol norlyda nortrel nylia
aubra eq aurovela aurovela 24 fe aurovela fe aviane ayuna azurette balziva bekyree blisovi 24 fe blisovi fe briellyn camila camrese camrese lo caziant charlotte 24 fe chateal chateal eq cryselle cyred cyred eq
nymyo ocella OPILL 7 philith
kalliga kariva
kelnor 1-35 kelnor 1-50 kurvelo larin larin 24 fe
pimtrea pirmella portia previfem reclipsen rivelsa setlakin sharobel simliya simpesse sprintec
dasetta daysee deblitane desogestrol-ethinyl estradiol ethinyl estradiol desogestrel-ethinyl estradiol dolishale drospirenone-ethinyl estradiol- levomefolate drospirenone-ethinyl estradiol elinest eluryng emoquette
larin fe larissia leena lessina levonest levonorgestrel-ethinyl estradiol ethinyl estradiol levonorgestrel-ethinyl estradiol-ferrous bisglycinate levonorgestrel-ethinyl estradiol levora-28 lo-zumandimine lojaimiess loryna low-ogestrel lutera lyleq lyza marlissa medroxyprogesterone 150 mg/ml vial melodetta 24 fe merzee mibelas 24 fe microgestin
sronyx syeda tarina 24 fe tarina fe taysofy tilia fe
tri femynor tri-estarylla tri-legest fe tri-linyah tri-lo-estarylla tri-lo-marzia tri-lo-mili tri-lo-sprintec tri-mili tri-nymyo tri-previfem
enilloring enpresse enskyce errin estarylla
ethynodiol-ethinyl estradiol etonogestrel-ethinyl estradiol falmina finzala gemmily gianvi
Generic medications are listed in all lowercase letters and brand-name medications are listed in all capital letters.
PPACA No Cost-Share Preventive Medications
Hormonal Contraception 5,6 (Cont.) tri-sprintec tri-vylibra tri-vylibra lo trivora-28
multivitamin with fluoride multivitamin-iron-fluoride mvc-fluoride POLY-VI-FLOR POLY-VI-FLOR WITH IRON
FLUBLOK QUAD FLUCELVAX QUAD FLULAVAL QUAD FLUMIST QUAD FLUZONE HIGH-DOSE QUAD FLUZONE QUAD GARDASIL 9 HAVRIX HEPLISAV-B HIBERIX INFANRIX DTAP IPOL JANSSEN COVID-19 VACCINE (EUA) KINRIX M-M-R II VACCINE MENQUADFI MENVEO A-C-Y-W-135-DIP
QUFLORA PED 0.25 MG/ML DROPS, 0.5 MG/ML DROPS, 1 MG CHEWABLE TABLET sodium fluoride oral drops and tablets TRI-VI-FLOR tri-vitamin with fluoride tri-vite with fluoride vitamins a,c,d and fluoride Quit Smoking Medications 5,9 Available to adults 18 years of age and older bupropion sr 150mg NICODERM CQ NICORETTE nicotine gum nicotine lozenge nicotine patch NICOTROL NICOTROL NS
tulana turqoz tydemy velivet vestura
vienva viorele volnea vyfemla vylibra wera wymzya fe
MODERNA COVID NOVAVAX COVID PEDIARIX
xulane zafemy zarah zovia 1-35 zumandimine Human Immunodeficiency Virus (HIV) Infection Pre-Exposure Prevention emtricitabine-tenofovir 200mg- 300mg 4,5,8 Implantable Contraception KYLEENA LILETTA MIRENA PARAGARD T380-A SKYLA Pediatric Multivitamins (Containing fluoride and fluoride supplements) Available to children six months – sixteen years of age FLORIVA DROPS, CHEWABLE TABLETS fluoride chewable tablets fluoritab ludent fluoride MULTI-VIT-FLOR
PEDVAXHIB PENBRAYA PENTACEL PENTACEL ACTHIB COMPONENT PFIZER COVID PNEUMOVAX 23
quit 2 quit 4 stop smoking aid varenicline Vaccines 10 ABRYSVO ACTHIB
PREHEVBRIO PREVNAR 20 PRIORIX PROQUAD QUADRACEL DTAP-IPV RECOMBIVAX HB ROTARIX
ROTATEQ SHINGRIX SPIKEVAX TDVAX TENIVAC TRUMENBA TWINRIX VAQTA VARIVAX VACCINE VAXELIS VAXNEUVANCE
ADACEL TDAP AFLURIA QUAD AREXVY BEXSERO BEYFORTUS BOOSTRIX TDAP COMIRNATY DAPTACEL DTAP DENGVAXIA DIPHTHERIA-TETANUS TOXOIDS-PED ENGERIX-B FLUAD FLUAD QUAD FLUARIX QUAD
Generic medications are listed in all lowercase letters and brand-name medications are listed in all capital letters.
1. This is a list of the medications and other products covered at 100% under the plan’s pharmacy benefit at this time, based on existing legal requirements, and is subject to plan terms like limitations and exclusions. For example, this list of medications may change if legal requirements for preventive coverage changes. 2. App/online store terms and mobile phone carrier/data charges apply. Customers under age 13 (and/or their parent/guardian) will not be able to register at myCigna.com. 3. Male condoms that are stocked behind the pharmacy counter and given to you by the pharmacist will be available at no cost-share to you. Quantity limits apply. 4. PPACA coverage requirements don’t apply to all plans. Log in to the myCigna App or myCigna.com, or check your plan materials, to find out how your plan covers these medications and how much they’ll cost you. 5. If your doctor feels these medications aren’t right for you, ask him or her to call Cigna Healthcare. There may be other generics/brands available at no cost-share to you 6. Generic hormonal contraceptives are available at no cost-share to you, even though they may not be listed here. 7. Opill is covered at no cost-share ($0) as long as you have a prescription from your doctor and fill at an in-network pharmacy. Quantity limits apply. 8. This medication will only be covered at no cost-share ($0) if used alone instead of in combination with other HIV medications. 9. Quantity limits apply. Also, generic nicotine replacement therapy (known as “store-brands”) are available at no cost-share to you, even though they may not be listed here. 10. Not all plans cover vaccines in the same way. Log in to the myCigna App or myCigna.com, or check your plan materials, to find out how your specific plan covers them. You can also see a current list of covered vaccines and pharmacies in your plan’s network. Most immunizations for travel aren’t covered. Call your pharmacy to make sure your plan covers the vaccine and it’s available at their location. You shouldn’t need to make an appointment to get a vaccination. If you use an out-of-network pharmacy, vaccines may not be covered or may be subject to your plan’s copay, coinsurance, and/or deductible. Para obtener ayuda en español llame al número en su tarjeta de Cigna Healthcare. Cigna Healthcare reserves the right to make changes to this drug list without notice. Your plan may cover additional medications; please refer to your enrollment materials for details. Cigna Healthcare does not take responsibility for any medication decisions made by the doctor or pharmacist. Cigna Healthcare may receive payments from manufacturers of certain preferred brand medications, and in limited instances, certain non-preferred brand medications, that may or may not be shared with your plan depending on its arrangement with Cigna Healthcare. Depending upon plan design, market conditions, the extent to which manufacturer payments are shared with your plan and other factors as of the date of service, the preferred brand medication may or may not represent the lowest-cost brand medication within its class for you and/or your plan. Health benefit plans vary, but in general to be eligible for coverage a drug must be approved by the Food and Drug Administration (FDA), prescribed by a health care professional, purchased from a licensed pharmacy and medically necessary. If your plan provides coverage for certain prescription drugs with no cost-share, you may be required to use an in-network pharmacy to fill the prescription. If you use a pharmacy that does not participate in your plan’s network, your prescription may not be covered, or reimbursement may be limited by your plan’s copayment, coinsurance or deductible requirements. Certain features described in this document may not be applicable to your specific health plan, and plan features may vary by location and plan type. Refer to your plan documents for costs and complete details of your plan’s prescription drug coverage. Product availability may vary by location and plan type and is subject to change. All group health insurance policies and health benefit plans contain exclusions and limitations. For costs and details of coverage, review your plan documents or contact a Cigna Healthcare representative. Cigna Healthcare products and services are provided exclusively by or through operating subsidiaries of The Cigna Group. 968433 d PPACA 03/24 © 2024 Cigna Healthcare.
DISCRIMINATION IS AGAINST THE LAW Medical coverage
Cigna complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Cigna does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. Cigna: • Provides free aids and services to people with disabilities to communicate effectively with us, such as: – Qualified sign language interpreters – Written information in other formats (large print, audio, accessible electronic formats, other formats) • Provides free language services to people whose primary language is not English, such as: – Qualified interpreters – Information written in other languages If you need these services, contact customer service at the toll-free number shown on your ID card, and ask a Customer Service Associate for assistance. If you believe that Cigna has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance by sending an email to ACAGrievance@Cigna.com or by writing to the following address: Cigna Nondiscrimination Complaint Coordinator PO Box 188016 Chattanooga, TN 37422 If you need assistance filing a written grievance, please call the number on the back of your ID card or send an email to ACAGrievance@Cigna.com. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at: U.S. Department of Health and Human Services 200 Independence Avenue, SW Room 509F, HHH Building Washington, DC 20201
1.800.368.1019, 800.537.7697 (TDD) Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company, Connecticut General Life Insurance Company, Evernorth Care Solutions, Inc., Evernorth Behavioral Health, Inc., Cigna Health Management, Inc., and HMO or service company subsidiaries of Cigna Health Corporation and Cigna Dental Health, Inc. The Cigna name, logos, and other Cigna marks are owned by Cigna Intellectual Property, Inc. ATTENTION: If you speak languages other than English, language assistance services, free of charge are available to you. For current Cigna customers, call the number on the back of your ID card. Otherwise, call 1.800.244.6224 (TTY: Dial 711). ATENCIÓN: Si usted habla un idioma que no sea inglés, tiene a su disposición servicios gratuitos de asistencia lingüística. Si es un cliente actual de Cigna, llame al número que figura en el reverso de su tarjeta de identificación. Si no lo es, llame al 1.800.244.6224 (los usuarios de TTY deben llamar al 711). 896375b 05/21 © 2021 Cigna.
Proficiency of Language Assistance Services English – ATTENTION: Language assistance services, free of charge, are available to you. For current Cigna customers, call the number on the back of your ID card. Otherwise, call 1.800.244.6224 (TTY: Dial 711). Spanish – ATENCIÓN: Hay servicios de asistencia de idiomas, sin cargo, a su disposición. Si es un cliente actual de Cigna, llame al número que figura en el reverso de su tarjeta de identificación. Si no lo es, llame al 1.800.244.6224 (los usuarios de TTY deben llamar al 711). Chinese – 注意：我們可為您免費提供語言協助服務。對於 Cigna 的現有客戶，請致電您的 ID 卡背面的號碼。其 他客戶請致電 1.800.244.6224 （聽障專線：請撥 711 ）。 Vietnamese – XIN LƯU Ý: Quý vị được cấp dịch vụ trợ giúp về ngôn ngữ miễn phí. Dành cho khách hàng hiện tại của Cigna, vui lòng gọi số ở mặt sau thẻ Hội viên. Các trường hợp khác xin gọi số 1.800.244.6224 (TTY: Quay số 711). Korean – 주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 현재 Cigna 가입자님들께서는 ID 카드 뒷면에 있는 전화번호로 연락해주십시오. 기타 다른 경우에는 1.800.244.6224 (TTY: 다이얼 711 ) 번으로 전화해주십시오. Tagalog – PAUNAWA: Makakakuha ka ng mga serbisyo sa tulong sa wika nang libre. Para sa mga kasalukuyang customer ng Cigna, tawagan ang numero sa likuran ng iyong ID card. O kaya, tumawag sa 1.800.244.6224 (TTY: I-dial ang 711). Russian – ВНИМАНИЕ: вам могут предоставить бесплатные услуги перевода. Если вы уже участвуете в плане Cigna, позвоните по номеру, указанному на обратной стороне вашей идентификационной карточки участника плана. Если вы не являетесь участником одного из наших планов, позвоните по номеру 1.800.244.6224 (TTY: 711). لحاليين برجاء االتصال بالرقم المدون علي ظهر بطاقتكم الشخصية. ا Cigna برجاء االنتباه خدمات الترجمة المجانية متاحة لكم. لعمالء – Arabic .( 711 اتصل ب :TTY) 1.800.244.6224 او اتصل ب French Creole – ATANSYON: Gen sèvis èd nan lang ki disponib gratis pou ou. Pou kliyan Cigna yo, rele nimewo ki dèyè kat ID ou. Sinon, rele nimewo 1.800.244.6224 (TTY: Rele 711). French – ATTENTION: Des services d’aide linguistique vous sont proposés gratuitement. Si vous êtes un client actuel de Cigna, veuillez appeler le numéro indiqué au verso de votre carte d’identité. Sinon, veuillez appeler le numéro 1.800.244.6224 (ATS : composez le numéro 711). Portuguese – ATENÇÃO: Tem ao seu dispor serviços de assistência linguística, totalmente gratuitos. Para clientes Cigna atuais, ligue para o número que se encontra no verso do seu cartão de identificação. Caso contrário, ligue para 1.800.244.6224 (Dispositivos TTY: marque 711). Polish – UWAGA: w celu skorzystania z dostępnej, bezpłatnej pomocy językowej, obecni klienci firmy Cigna mogą dzwonić pod numer podany na odwrocie karty identyfikacyjnej. Wszystkie inne osoby prosimy o skorzystanie z numeru 1 800 244 6224 (TTY: wybierz 711). Japanese – 注意事項：日本語を話される場合、無料の言語支援サービスをご利用いただけます。現在のCignaの お客様は、IDカード裏面の電話番号まで、お電話にてご連絡ください。その他の方は、 1.800.244.6224 （ TTY: 711 ） まで、お電話にてご連絡ください。 Italian – ATTENZIONE: Sono disponibili servizi di assistenza linguistica gratuiti. Per i clienti Cigna attuali, chiamare il numero sul retro della tessera di identificazione. In caso contrario, chiamare il numero 1.800.244.6224 (utenti TTY: chiamare il numero 711). German – ACHTUNG: Die Leistungen der Sprachunterstützung stehen Ihnen kostenlos zur Verfügung. Wenn Sie gegenwärtiger Cigna-Kunde sind, rufen Sie bitte die Nummer auf der Rückseite Ihrer Krankenversicherungskarte an. Andernfalls rufen Sie 1.800.244.6224 an (TTY: Wählen Sie 711). ٬ لطفا با شمارهای که در Cigna توجه: خدمات کمک زبانی٬ به صورت رايگان به شما ارائه میشود. برای مشتريان فعلی – Persian (Farsi) را 711 تماس بگيريد )شماره تلفن ويژه ناشنوايان: شماره 1.800.244.6224 پشت کارت شناسايی شماست تماس بگيريد. در غير اينصورت با شماره شمارهگيری کنيد(. 896375b 05/21
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