Coverage for pharmacy items For 100% coverage of your over-the-counter (OTC) drugs and other pharmacy items listed here, you must: • Meet certain age requirements and other rules • Receive and fill prescriptions from doctors, pharmacies, or other healthcare professionals in your plan’s network • Have prescriptions, including for OTC items Women’s preventive drugs and other pharmacy items (age appropriate): • Breast cancer risk-reducing medications, such as tamoxifen, raloxifene, and aromatase inhibitors, that follow the U.S. Preventive Services Task Force criteria2 • Contraceptives, including generic prescription drugs and OTC items like condoms and spermicides7,8 • Folic acid for women ages 55 or younger who are planning to become pregnant • Low-dose aspirin (81 mg) for pregnant women who have an increased risk of preeclampsia Adult preventive drugs and other pharmacy items (age appropriate): • Aspirin use (81 mg and 325 mg) for the prevention of cardiovascular disease (CVD), preeclampsia, and colorectal cancer in adults younger than age 70 • Colonoscopy prep kit (generic or OTC only) when prescribed for preventive colon screening for members ages 45 to 75 • Generic low-to-moderate dose statins for members ages 40 to 75 who have one or more CVD risk factors (dyslipidemia, diabetes, hypertension, or smoking) • Preexposure prophylaxis (PrEP) for the prevention of HIV • Tobacco cessation products, including all FDA- approved brand-name and generic OTC and prescription products, for members ages 18 and older Child preventive drugs and other pharmacy items (age appropriate): • Dental fluoride varnish to prevent tooth decay in children ages 5 and younger • Fluoride supplements for children ages 6 and younger I r e b m u n s e civ r e S r e b m e M e h t ll a c ,st fi e n e b e r a c e vit n e v e r p r u o y g n i d n a tsr e d n u p l e h e r o m e kil d’u o y f o e l b a d r o ff A e h t r e d n u s g u r d e vit n e v e r p d e r e v o c f o tsil e t e l p m o 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ecioh C htla e H m ehtn A :kroY w e N fo seitnuoc nretsa ehtuos 71 nI .cnI ,n alP htla e H notnrohT w ehtta M yb nettirwre d nu d n a .cnI ,erihsp m a I fo ytiC eht rof tp ecxe ainigriV fo lla si a era ecivres rieht d n a ,e g arevoc O M H g nidivorp sre p eeKhtla e H m ehtn A sa se d art .cnI ,sre p eeKhtla e H etailfifa sti d n a ,dleihS eulB d n a ssorC eulB m ehtn A sa se d art .cnI ,ainigriV fo sn alP htla e H m ehtn A :ainigriV nI .yn a p m oC ecn arusnI ytinu m m oC :oih O n F ecn arusnI secivreS htla e H eracp m oC yb d ereffo seicilo p S O P ni stfiene b kro wten-fo-tuo eht setirwre d nu d n a seicilo p ytin m e d ni d n a O P P sretsini m d a ro setirwre d nu ,)I W S B C B( nisnocsi W fo dleihS eulB ssorC eulB :nisnocsi W nI .321 etuoR etatS fo tsa e a era eht d n a ,a n neiV fo n w oT eht ,xafria C si m ehtn A .noitaicossA dleihS eulB d n a ssorC eulB eht fo seesnecil tne d ne p e d nI .seicilo p S O P ro O M H ytiroirP lle W sretsini m d a ro setirwre d nu CIC W ;seicilo p S O P ro O M H sretsini m d a ro setirwre d nu eracp m oC .)CIC W ( noitaro proC ecn arusnI evitaro b alloC nisnocsi W ro )eracp m oC( noitaro pro a .cnI ,sein a p m oC ecn arusnI m ehtn A fo kra m e d art d eretsig er 4 9913 M D O P V S B A N E M U 32/80