Breast Cancer Preventive Medication Requirements

PBIRx®

Intelligent Solutions in Pharmacy Benefits

612 Wheelers Farms Road, Milford, CT 06461

(888) 797-2479

Did you know? For plan or policy years that began on or after September 24, 2014, preventive medications for breast cancer are required to be available at a $0.00 copay to women who display a high risk for the disease. However, mandated by the U.S Preventive Services Task Force (USPSTF), this requirement only applies to non-grandfathered group health plans. Do you fall within this category?

Being that these services can come at an extremely high cost otherwise, it is important for benefit providers to be aware of the changes to ensure that they have been put into effect appropriately where applicable. If they have not been and your employees or members are eligible to receive these services without cost sharing limitations, it is crucial for you to connect with an experienced team that can oversee their implementation.

Our Role

Here at PBIRx, we will work closely with your PBM to ensure that your plan covers the recommended medications - tamoxifen and raloxifene - for women who have a high risk of developing breast cancer. For those who do not have a high risk, copays will be required at the time of service.

For more information about the latest USPSTF mandates as they relate to your pharmacy benefit plan, please give us a call at (888) 797-2479 today.