Updated Coverage for Breast Cancer prevention medications

Beginning October 1, 2020, most of Empire BlueCross BlueShield’s ACA-complaint non-grandfathered health plans will cover generic aromatase inhibitors at 100%, no member cost share for members who are prescribed these drugs for prevention of breast cancer and use an in-network pharmacy. Prior authorization will be required; providers will need to complete a questionnaire and submit to IngenioRx for consideration.  Women must be 35 years or older and have no history of breast cancer.

 

This coverage change aligns with the updated USPSTF “B” recommendation regarding Breast Cancer: Medication Use to Reduce Risk. This updated recommendation now includes aromatase inhibitors among medications that can reduce risk of breast cancer (in addition to tamoxifen or raloxifene). The USPSTF recommends that clinicians offer to prescribe risk-reducing medications, such as tamoxifen, raloxifene, or aromatase inhibitors, to women who are at increased risk for breast cancer and at low risk for adverse medication effects.

 

Providers can contact the provider service number on the back of the member ID card to determine if a member’s plan includes this benefit.

 

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