PreventiveRx Enhanced Drug List (California Select Drug List)
Lists prescription preventive medications that may be covered at low or no cost under the Enhanced Plan (California Select Drug List). Affects members and providers using the PreventiveRx benefit; inclusion does not guarantee coverage for every plan.
No material clinical or coverage changes in this revision.
Coverage Criteria
Brand-name drugs that have a generic equivalent available are not covered under the PreventiveRx benefit. This policy uses generic (lowercase) and brand (capitalized) naming conventions on the list to indicate equivalence; when a generic equivalent exists, the brand formulation is excluded from PreventiveRx coverage. Refer to the member's Certificate or Evidence of Coverage for plan-specific implications and any exceptions.
Continuous Glucose Monitors (CGMs) are expressly not included in PreventiveRx Coverage. While certain diabetic supplies may be covered when a prescription is provided, CGMs are excluded from the PreventiveRx preventive drug list and should be obtained or requested through the member’s medical or durable medical equipment benefits as appropriate.
Some drugs used for cosmetic purposes may be excluded from benefits under this PreventiveRx listing. Inclusion on the PreventiveRx list does not guarantee coverage for every use or every plan; providers and members should consult the member’s Certificate or Evidence of Coverage for specific coverage limitations, exclusions, and any plan-level exceptions.
Provider Actions & Notices
Diabetic supplies requirement
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