CurrentAnthemPolicy N/A

PreventiveRx Plan Básico Plus National Drug List (Direct Plus)

A preventive medication list (PreventiveRx) for the Plan Básico Plus (Lista Nacional de Medicamentos Direct Plus) describing which prescription preventive drugs are covered under the PreventiveRx benefit, general rules about brand vs generic, and limited coverage details for diabetes supplies.

Policy Summary

PayerAnthem

PolicyPreventiveRx Plan Básico Plus National Drug List (Direct Plus)

Policy CodePolicy N/A

Change TypeNo material change

Effective Date

Next Review Date

Key ActionProviders must provide a prescription to obtain covered diabetes supplies (meters, strips, lancets); coverage limited to Accu-Chek and FreeStyle products.

POLICY UPDATE CHANGES

No material clinical/coverage changes in this update.

multipleListed Preventive Drug Categories (examples)

2Diabetes meter brands covered

0Continuous Glucose Monitors covered

PreventiveRx — Plan Básico Plus (Direct Plus) Summary

PreventiveRx covers medications intended to keep members healthy by preventing diseases and medical conditions. The list includes only prescription products and many example drugs are provided across therapeutic categories such as asthma, diabetes, cardiac, cholesterol, mental health, and osteoporosis.

For diabetes supplies, a prescription is required to obtain covered items (blood glucose meters, test strips, lancets). Coverage for meters and test strips is limited to Accu-Chek and FreeStyle products; continuous glucose monitors (CGMs) are not covered under PreventiveRx.

General PreventiveRx Coverage Rules

Covered when ALL of the following are met:

ALL of the following

Medication is listed on the PreventiveRx list for Plan Básico Plus (Lista Nacional de Medicamentos Direct Plus).
Medication is a prescription product (the list includes only prescription products).
Brand-name medications with a generic equivalent available are not covered under the PreventiveRx benefit.
If a generic equivalent exists, the brand is excluded from this benefit.

Diabetes Supplies Coverage Criteria

Covered when ALL of the following are met:

ALL of the following

A prescription is provided for diabetes supplies (e.g., blood glucose meters, test strips, lancets).
Only Accu-Chek and FreeStyle brand blood glucose meters and test strips are covered under this benefit.
Continuous glucose monitors (CGMs) are not included in this benefit.
CGMs explicitly excluded from PreventiveRx coverage.

Actionable Requirements for Providers

Documentation Required

Prescription required for diabetes supplies

Providers must submit a prescription to obtain covered diabetes supplies. Coverage is limited to Accu‑Chek and FreeStyle blood glucose meters and test strips; lancets are also covered with a prescription. Continuous glucose monitors (CGMs) are not included in this benefit.

Covered brands: Accu‑Chek; FreeStyle
CGMs are excluded from PreventiveRx coverage