Have you ever had the experience of picking up a prescription and finding out you have a $0 copay? That means that you likely have been prescribed for a drug covered by the Affordable Care Act as a “preventive” drug. These drugs may have certain conditions associated with them to be deemed free but if you meet those requirements you might find yourself pleasantly surprised. Some examples are Prescriptions for:

• Aspirin to prevent cardiovascular disease and colorectal cancer
• Aspirin to help women prevent morbidity and mortality from Preeclampsia
• Folic Acid supplements for women planning for a pregnancy
• Certain tobacco cessation products
• Immunizations for adults and children for certain diseases
• Blood screening for colorectal cancer
• Oral and emergency contraceptives for women
• Medications for risk reduction of breast cancer in women

If you are in one of our Consumer Directed Health Plans – the Aetna CDHP or the Basic Choice plan you might notice that while not free – certain prescriptions are not subject to your deductible but are rather jumping right up to your coinsurance.

As a reminder, if you have the individual policy and are subjected to a $1,500 deductible (which you must pay before the plan pays) – most drugs you purchase prior to meeting your deductible would cost you the full amount of the CVS negotiated price.

However for a certain broader class of preventive therapy drugs – the deductible would not apply – you would simply pay 20% of the cost of the drug up to a $100 per script maximum (which if you are hitting that maximum it means the actual drug costs more than $500 per fill).

Some examples of this type of prescription would be:

• Anti-Infectives (ex. Truvada)
• Anticoagulants (ex. Coumadin)
• Cardiovascular Conditions – (ex. Multaq)
• Diabetes – (ex. Lantus, Novolog, Trulicity)
• Mental Health – (ex. Prozac, Wellbutrin, Zoloft)
• Respiratory – Flovent, Xolair

There are actually a large number of these deductible by-passing medications. To find out if your drugs would have a free preventive care option – or if you are in our CDHP, whether there are deductible by-passing alternatives feel you can use the “Check Drug Cost and Coverage” tool on the www.caremark.com site or call Caremark at 866-240-4921.