Health Care Reform Preventative Drug list At Magellan Rx Management, we are driven to helping our clients most effectively manage changes in the prescription drug environment. As part of the Patient Protection and Affordable Care Act (PPACA), effective on or after August 1, 2012 non-grandfathered plans are required to cover select FDA-approved drug products related to preventive health services for Adults, Children and Women without a member having to pay a copayment, co-insurance, or meet a deductible. As your pharmacy benefits manager, we will support coverage of specific products at $0 copay as prescription benefit plans become subject to the law. Magellan Rx Management will also routinely update FDA-approved product lists to comply with the Preventive Health mandates and require prescriptions for product coverage. MRx has created ten specific lists that address the preventive health requirements above. A plan is required to cover all the drug lists below, either through the pharmacy or medical benefits. If the plan needs advice regarding coverage, MRx recommends the plan connect with their respective legal counsel. The content of the list will be maintained by Magellan Rx Management and will be continually reviewed and updated to ensure compliance with healthcare reform mandates. UPDATE: For plan years beginning on or after September 24, 2014 (January 1, 2015 for calendar year plans), non-grandfathered health plans are required to cover prescription medications designed to reduce the risk of breast cancer in women, without cost-sharing, subject to reasonable medical management. These required drugs have been added to the “Preventive Health for Adults, Children and Women: Prescription and OTC Products” list below. For plan years beginning on or after July 1, 2020 (January 1, 2021 for calendar year plans), non-grandfathered health plans are required to cover prescription medications designed for HIV Pre-Exposure Prophylaxis without cost-sharing, subject to reasonable medical management. These required drugs have been added to the Preventive Health for Adults: HIV Pre-Exposure Prophylaxis (PrEP). For plan years beginning on or after October 1, 2020 (January 1, 2021 for calendar year plans), non-grandfathered health plans are required to cover prescription medications designed for Breast Cancer without cost-sharing, subject to reasonable medical management. These required drugs have been added to the Preventive Health for Women: Breast Cancer. 1. Preventive Health for Adults, Children and Women: Prescription and OTC Products. Age edits may apply. Generic Name Label Name Rx or OTC Form aspirin Adult Aspirin Regimen Ec 81 Mg OTC ORAL aspirin Adult Low Dose Asa Ec 81 Mg Tb OTC ORAL aspirin Aspir Ec 81 Mg Tablet OTC ORAL aspirin Aspirin 325 Mg Tablet OTC ORAL magellanrx.com Generic Name Label Name Rx or OTC Form aspirin Aspirin 81 Mg Chewable Tablet OTC ORAL aspirin Aspirin Ec 325 Mg Caplet OTC ORAL aspirin Aspirin Ec 325 Mg Tablet OTC ORAL aspirin Aspirin Ec 81 Mg Tablet OTC ORAL aspirin Aspir-Low Ec 81 Mg Tablet OTC ORAL aspirin Aspir-Trin Ec 325 Mg Tablet OTC ORAL aspirin Bayer Aspirin 325 Mg Caplet OTC ORAL aspirin Bayer Aspirin 325 Mg Tablet OTC ORAL aspirin Bayer Aspirin 81 Mg Chew Tab OTC ORAL aspirin Child Aspirin 81 Mg Chew Tab OTC ORAL aspirin Child Aspirin 81 Mg Tab Chew OTC ORAL ferrous sulfate Child Ferrous Sulfate 15 Mg/Ml OTC ORAL ferrous sulfate Children'S Iron 15 Mg/Ml Drops OTC ORAL aspirin Cvs Aspirin 325 Mg Caplet OTC ORAL aspirin Cvs Aspirin 325 Mg Tablet OTC ORAL aspirin Cvs Aspirin 81 Mg Chewable Tab OTC ORAL aspirin Cvs Aspirin Ec 325 Mg Tablet OTC ORAL aspirin Cvs Aspirin Ec 81 Mg Tablet OTC ORAL folic acid Cvs Folic Acid 800 Mcg Tablet OTC ORAL aspirin Ecotrin Ec 325 Mg Tablet OTC ORAL aspirin Ecotrin Ec 81 Mg Tablet OTC ORAL aspirin Ecpirin Ec 325 Mg Tablet OTC ORAL aspirin Eq Aspirin 325 Mg Tablet OTC ORAL aspirin Eq Aspirin 81 Mg Chewable Tab OTC ORAL aspirin Eq Aspirin Ec 325 Mg Tablet OTC ORAL aspirin Eq Aspirin Ec 81 Mg Tablet OTC ORAL aspirin Eql Aspirin 325 Mg Tablet OTC ORAL aspirin Eql Aspirin 81 Mg Chewable Tab OTC ORAL aspirin Eql Aspirin Ec 325 Mg Tablet OTC ORAL aspirin Eql Aspirin Ec 81 Mg Tablet OTC ORAL folic acid Fa-8 Capsules OTC ORAL ferrous sulfate Ferosul 220 Mg/5 Ml Elixir OTC ORAL ferrous sulfate Ferrous Sulf 15 Mg Iron/Ml Drp OTC ORAL ferrous sulfate Ferrous Sulf 220 Mg/5 Ml Elix OTC ORAL ferrous sulfate Ferrous Sulf 220 Mg/5 Ml Liq OTC ORAL ferrous sulfate Ferrous Sulf 300 Mg/5 Ml Liq OTC ORAL ferrous sulfate Ferrous Sulf 44 Mg Iron/5Ml Lq OTC ORAL fluoride (sodium) Fluoride 0.25 Mg Tablet Chew RX ORAL fluoride (sodium) Fluoride 0.5 Mg Tablet Chew RX ORAL fluoride (sodium) Fluoride 1 Mg Tablet Chewable RX ORAL fluoride (sodium) Fluoritab 0.5 Mg Tablet Chew RX ORAL fluoride (sodium) Fluoritab 1 Mg Tablet Chew RX ORAL fluoride (sodium) Flura-Drops 0.25 Mg/Drop RX ORAL folic acid Folic Acid 0.4 Mg Tablet OTC ORAL folic acid Folic Acid 0.8 Mg Tablet OTC ORAL folic acid Folic Acid 20 Mg Capsule OTC ORAL folic acid Folic Acid 400 Mcg Tablet OTC ORAL folic acid Folic Acid 800 Mcg Capsule OTC ORAL folic acid Folic Acid 800 Mcg Tablet OTC ORAL aspirin Gnp Aspirin 325 Mg Tablet OTC ORAL aspirin Gnp Aspirin 81 Mg Chewable Tab OTC ORAL aspirin Gnp Aspirin Ec 325 Mg Tablet OTC ORAL aspirin Gnp Aspirin Ec 81 Mg Tablet OTC ORAL folic acid Gnp Folic Acid 400 Mcg Tablet OTC ORAL aspirin Gnp Lite Coat Asa 325 Mg Tab OTC ORAL aspirin Gs Aspirin 325 Mg Tablet OTC ORAL aspirin Gs Aspirin 81 Mg Chewable Tab OTC ORAL magellanrx.com 2 | 2020 Magellan Rx Management, LLC. All Rights Reserved_1220 Generic Name Label Name Rx or OTC Form aspirin Gs Aspirin Ec 325 Mg Tablet OTC ORAL aspirin Gs Aspirin Ec 81 Mg Tablet OTC ORAL aspirin Hm Aspirin 325 Mg Tablet OTC ORAL aspirin Hm Aspirin 81 Mg Chewable Tab OTC ORAL aspirin Hm Aspirin Ec 325 Mg Tablet OTC ORAL aspirin Hm Aspirin Ec 81 Mg Tablet OTC ORAL folic acid Hm Folic Acid 400 Mcg Tablet OTC ORAL ferrous sulfate Iron 65 Mg Tablet OTC ORAL aspirin Kro Aspirin 325 Mg Tablet OTC ORAL aspirin Kro Aspirin 81 Mg Chewable Tab OTC ORAL aspirin Kro Aspirin Ec 325 Mg Tablet OTC ORAL aspirin Kro Aspirin Ec 81 Mg Tablet OTC ORAL aspirin Lite Coat Aspirin 325 Mg Tab OTC ORAL aspirin Low Dose Aspirin Ec 81 Mg Tab OTC ORAL fluoride (sodium) Ludent Fluoride 0.25 Mg Tb Chw RX ORAL fluoride (sodium) Ludent Fluoride 0.5 Mg Tb Chew RX ORAL fluoride (sodium) Ludent Fluoride 1 Mg Tab Chew RX ORAL ferrous sulfate Pharm Chc Ped Iron 15Mg/Ml Drp OTC ORAL aspirin Pub Aspirin 325 Mg Tablet OTC ORAL aspirin Pub Aspirin 81 Mg Chewable Tab OTC ORAL aspirin Qc Aspirin 325 Mg Tablet OTC ORAL aspirin Qc Aspirin 81 Mg Chewable Tab OTC ORAL aspirin Qc Aspirin Ec 325 Mg Tablet OTC ORAL aspirin Qc Aspirin Ec 81 Mg Tablet OTC ORAL aspirin Qc Lo-Dose Aspirin Ec 81 Mg Tb OTC ORAL aspirin Ra Aspirin 325 Mg Tablet OTC ORAL aspirin Ra Aspirin 81 Mg Chewable Tab OTC ORAL aspirin Ra Aspirin Ec 325 Mg Tablet OTC ORAL aspirin Ra Aspirin Ec 81 Mg Tablet OTC ORAL folic acid Ra Folic Acid 0.4 Mg Tablet OTC ORAL folic acid Ra Folic Acid 800 Mcg Tablet OTC ORAL aspirin Sb Aspirin 325 Mg Tablet OTC ORAL aspirin Sm Aspirin 325 Mg Tablet OTC ORAL aspirin Sm Aspirin 81 Mg Chewable Tab OTC ORAL aspirin Sm Aspirin Ec 325 Mg Tablet OTC ORAL aspirin Sm Aspirin Ec 81 Mg Tablet OTC ORAL aspirin Sm Child Aspirin 81 Mg Chw Tab OTC ORAL folic acid Sm Folic Acid 0.4 Mg Tablet OTC ORAL folic acid Sm Folic Acid 400 Mcg Tablet OTC ORAL fluoride (sodium) Sodium Fluoride 0.25 (0.55) Mg RX ORAL fluoride (sodium) Sodium Fluoride 0.5 Mg(1.1 Mg) RX ORAL fluoride (sodium) Sodium Fluoride 0.5 Mg/Ml Drop RX ORAL fluoride (sodium) Sodium Fluoride 0.5 Mg/Ml Drop OTC ORAL fluoride (sodium) Sodium Fluoride 1 Mg (2.2 Mg) RX ORAL aspirin St. Joseph Aspirin 81 Mg Chew OTC ORAL aspirin St. Joseph Aspirin Ec 81 Mg Tb OTC ORAL folic acid Sv Folic Acid 800 Mcg Tablet OTC ORAL Bowel Prep Products: Quantity limit and age edits apply peg 3350/mannitol/sodium bicarbonate/citric acid/sucrose Base, Pcca Rapid Dissolve Powd OTC MISCELL peg 3350/sod sulf/sod bicarb/sod chloride/potassium chloride Gavilyte-C Solution RX ORAL peg 3350/sod sulf/sod bicarb/sod chloride/potassium chloride Gavilyte-G Solution RX ORAL sodium chloride/sodium bicarbonate/potassium chloride/peg Gavilyte-N Solution RX ORAL magellanrx.com 3 | 2020 Magellan Rx Management, LLC. All Rights Reserved_1220 RX/OTC Generic Name Label Name Form (FDB) Bowel Prep Products: Quantity limit and age edits apply peg 3350/sod sulf/sod bicarb/sod chloride/potassium chloride Peg 3350 Electrolyte Soln RX ORAL sodium chloride/sodium bicarbonate/potassium chloride/peg Peg 3350-Electrolyte Solution RX ORAL peg 3350/sodium sulfate/sod chloride/kcl/ascorbate sod/vit c Peg3350 100-7.5-2.691-1.01-5.9 RX ORAL peg 3350/sod sulf/sod bicarb/sod chloride/potassium chloride Peg-3350 And Electrolytes Soln RX ORAL polyethylene glycol 3350 Polyethylene Glycol 3350 Powd OTC ORAL polyethylene glycol 3350 Polyethylene Glycol 3350 Powd RX MISCELL polyethylene glycol 3350 Polyethylene Glycol 3350 Powd OTC MISCELL sodium chloride/sodium bicarbonate/potassium chloride/peg Trilyte With Flavor Packets RX ORAL COVID 19 Vaccines covid-19 vaccine, mrna-1273, lnp-s (moderna)/pf Moderna Covid19 Vacc RX INTRAMUSC covid-19 vaccine, mrna, bnt162b2, lnp-s(pfizer)/pf Pfizer Covid19 Vacc RX INTRAMUSC Risk-Reducing Drugs for Breast Cancer: Gender edits apply raloxifene hcl Raloxifene Hcl 60 Mg Tablet RX ORAL tamoxifen citrate Tamoxifen 10 Mg Tablet RX ORAL tamoxifen citrate Tamoxifen 20 Mg Tablet RX ORAL Rx Statins Age Edits: