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Drug Coverage and Preventive Care – June 2011

The health care reform law requires Empire to cover certain preventive care services with no member cost-sharing. As outlined in regulations from the U.S. Department of Health and Human Services (HHS), these services include:  

Preventive care services defined by the U.S. Preventive Services Task Force

Vaccines recommended by the Advisory Committee on Immunization Practices

Screenings and preventive care recommended by the Health Resources and Services Administration

These requirements became effective for policies upon renewal on or after September 23, 2010. Some plans are grandfathered, and not subject to the new preventive care coverage requirements, so providers should continue to verify eligibility and benefits through their normal business processes. 
At this time, we have not changed our drug list because of the preventive care provision. We believe the preventive care coverage recommendations are intended to address the care and services provided by the doctor. For example, in evaluating the regulations, we have interpreted the language to include coverage of counseling related to the use of certain medications such as aspirin, folic acid, iron supplements and fluoride. Based on the language in this legislation, we do not believe that the recommendations are intended to cover the medications themselves. 
Further guidance or clarifications from HHS may result in a different interpretation of the regulations, at which time Empire will make any appropriate changes in preventive coverage benefits for our members.  
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