Your pharmacy benefits pays 100% of certain preventive drug with no out-of-pocket costs to you. A preventive drug is used to help avoid disease and maintain health. These drugs are considered effective in preventing the development of a health condition or a disease.
Drugs Covered at 100%
Preventive drugs are covered at 100% when:
- You have a prescription from your doctor for it,
- You fill your prescription at an in-network pharmacy, and
- The drugs are identified as preventitive drugs that are covered at no cost under the Affordable Care Act (ACA). The ACA requires that health insurance providers cover certain preventive drugs at no cost for members.
Additional rules, such as prior authorization, may be required for some medications.
Special note: You or the prescriber should verify with Navitus Health Solutions, the state’s pharmacy benefits manager, if a generic drug must be tried before the brand version of a drug is filled.
Find preventive drugs that are covered at 100% by your plan:
- Go to the Navitus ETF Benefits website.
- Select your health plan design.
- Select Formulary.
- Select the Preventive Drug Coverage Guidelines list.
A formulary is a list of all the drugs and supplies that are covered by the benefit. The formulary for active employees and retirees without Medicare can change throughout the year. Medications are subject to formulary coverage.