CurrentAnthemPolicy N/A

PreventiveRx National Drug List (Enhanced Plan)

Lists prescription drugs included in the PreventiveRx benefit for the Enhanced Plan and provides member language/access notices; affects members covered by the Enhanced Plan drug benefit.

Policy Summary

PayerAnthem

PolicyPreventiveRx National Drug List (Enhanced Plan)

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionDiabetic supplies (meters, test strips, lancets) require a prescription to be covered by this plan.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

PreventiveRxbenefit name included

nationaldrug list scope

providedlanguage/access notices

711TTY/TDD

1-800-368-1019HHS OCR phone

PreventiveRx Coverage Criteria

Inclusion and exclusion rules

Coverage guidance and limitations shown on the drug list

PreventiveRx inclusion rules: Drug must be a prescription listed on the PreventiveRx list;Brand-name drugs that have a generic equivalent available are not covered under this PreventiveRx benefit.

Coverage limitations and exclusions: Some drugs on the list (for example, drugs used for cosmetic purposes) may be excluded from benefits; refer to the member's Certificate or Evidence of Coverage for specific limitations and exclusions.

Diabetes‑specific rules: Diabetic supplies (including blood glucose meters, test strips, and lancets) require a prescription to be covered by this plan; only blood glucose meters and test strips for Accu‑Chek and FreeStyle products are covered under this benefit; Continuous Glucose Monitors (CGMs) are not covered.

PreventiveRx covers prescription drugs intended to prevent illness or other health conditions and may be available at low or no cost depending on the member's benefit. The list includes only prescription products; brand-name drugs are shown with an initial capital and generics are shown in lowercase.

Policy Summary

PayerAnthem

PolicyPreventiveRx National Drug List (Enhanced Plan)

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionDiabetic supplies (meters, test strips, lancets) require a prescription to be covered by this plan.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Provider Actions, Notices, and Filing

Denial Risk

Denial / Complaint Triggers

Failure to provide required language assistance or to treat members without discrimination (based on race, color, national origin, sex, age, or disability) may be grounds for a complaint or grievance and can affect coverage determinations.

Language assistance failure
Discriminatory treatment

Note

How to File a Complaint (Grievance)

Members may file a written complaint (grievance) if they believe services were denied improperly or if they experienced discrimination or failure to receive language assistance. Complaints can be mailed to the Compliance Coordinator or filed with HHS OCR.

Mail: Compliance Coordinator, P.O. Box 27401, Mail Drop VA2002-N160, Richmond, VA 23279
HHS OCR: 200 Independence Avenue, SW; Room 509F, HHH Building; Washington, D.C. 20201
HHS OCR phone: 1-800-368-1019 (TDD: 1-800-537-7697)
Online: https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
Complaint forms: http://www.hhs.gov/ocr/office/file/index.html
For help with language services or TTY/TDD: call Member Services number on ID card (TTY/TDD: 711)

Background and Scope

This document is the PreventiveRx drug list for the Enhanced Plan and defines which prescription medications are included in the plan's preventive benefit. It is intended to inform providers and billing staff which drugs are considered part of the PreventiveRx benefit and to describe any general coverage limitations.

The scope covers prescription preventive medications listed by therapeutic category on the national drug list. Coverage is limited to the products shown on this list; brand-name drugs with available generic equivalents are not covered, and certain products (for example, drugs used for cosmetic purposes) may be excluded per the member's Certificate or Evidence of Coverage.

Key Definitions

PreventiveRx (definition and coverage-at-low-or-no-cost summary)

DefinitionPreventiveRx: Drugs that may keep you healthy because they may prevent illness and other health conditions; this list includes only prescription products.

Cost to memberPreventiveRx drugs are available at low or no cost to you depending on your benefit.

Brand vs genericBrand-name drugs are listed with a first capital letter; non-brand (generic) drugs are in lowercase.

Coverage exclusionBrand-name drugs that have a generic equivalent available are not covered under this PreventiveRx benefit.

Scope and limitationsNot all drugs on this list may be covered by your plan; some drugs (e.g., for cosmetic purposes) may be excluded — refer to your Certificate or Evidence of Coverage.

Grievance / Complaint (definition and filing locations)

DefinitionGrievance/Complaint: A report filed by a member alleging failure to provide required services (for example language assistance) or discrimination under federal civil rights laws.

File with Compliance CoordinatorYou may file a written complaint to: Compliance Coordinator, P.O. Box 27401, Mail Drop VA2002-N160, Richmond, VA 23279.

File with HHS OCRYou may file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights (OCR) at 200 Independence Avenue, SW; Room 509F, HHH Building; Washington, D.C. 20201, by phone 1-800-368-1019 (TDD: 1-800-537-7697), or online at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf.

Assistance contactFor language assistance or aids/services for people with disabilities, call the Member Services number on your ID card (TTY/TDD: 711).