The Affordable Care Act mandated changes to pharmacy programs. Some preventive medications are now available at no cost to members, while other drugs are no longer covered. Changes are effective for the 2014 plan year for Blue Cross® Blue Shield® of Michigan/Blue Care Network of Michigan individual and small group (employer with less than 50 employees) plans.
Medications available at no cost to members:
These medicines are considered preventive, an important element of the Affordable Care Act, and are provided at no cost to the member, as long as they are prescribed by their health care provider and filled through a participating pharmacy.
- Aspirin (generic only) for men 45 – 79 and women 55 – 79 to prevent cardiovascular disease
- Generic and select brand name contraceptives (certain other brand name contraceptives will be subject to cost sharing.)
- Folic acid (Vitamin B9) for females who are or may become pregnant
- Fluoride for children ages 6 months – 5 years who do not get it in their water source
- Iron supplements for newborns - 12 months if at risk for anemia
- Smoking cessation medication (certain medications may require step therapy)
- Vitamin D (generic) for adults age 65 or older who are at risk for falls
Drugs that have been removed from the list of covered drugs:
- Any brand name drug for which there is a generic equivalent
- Over-the-counter medications, unless considered preventive (see above)
- Drugs with comparable medications available over-the-counter, including cough/cold medicines
- Select high-abuse drugs, such as Opana ER, Actiq, and Fentora, along with some sleep medications
- Lifestyle drugs such as those for erectile dysfunction or weight loss
- Dietary supplements
- Compounded drugs
- Most non-sedating antihistamines (Zyrtec, Claritin, Allegra, Clarinex)
- Drugs used for cosmetic purposes (such as wrinkle-removing face cream like Renova or Vaniqua)
- Prenatal vitamins other than folic acid (folic acid is considered the most important. Other prenatal vitamins are readily available at reasonable cost over the counter).
- Brand name drugs used to treat heartburn and acid reflux like Nexium and Dexilant. Generic drugs are covered.
To request approval for an excluded medication or one that requires prior authorization, prescribing physicians can contact BCBSM/BCN at 1-800-437-3803. Reviews take 72 hours. (In some cases, members will need new authorization for a medication that was previously authorized).
Employers can download the BCBSM/BCN Custom SELECT Prescription List in the Client Login section at www.thesalusgroup.com. Members can find additional information from their health care provider, their pharmacist or the at the member portal of the www.bcbsm.com.Go to main navigation