CurrentBlue Cross Blue Shield - North CarolinaPolicy N/A

HSA Preventive Drug List

Lists prescription drugs and diabetic supplies designated as preventive under certain HSA/HDHP-aligned benefit plans for Blue Cross Blue Shield - North Carolina; affects members whose plans include the HSA Preventive Drug coverage feature and providers/pharmacies dispensing these medications.

Policy Summary

PayerBlue Cross Blue Shield - North Carolina

PolicyHSA Preventive Drug List

Policy CodePolicy N/A

Change TypeNo material change

Effective DateJan 1, 2025

Next Review DateN/A

Key ActionVerify the member's specific plan and benefit materials for HSA Preventive Drug coverage and any generic-first or prior authorization requirements before dispensing.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

2025-01-01policy effective date

20+drug categories (partial)

100+individual drug listings (partial)

Yesincludes diabetic supplies

Preventive Drug Coverage Criteria

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Preventive Drug List coverage

Covered when ALL of the following are met:

Preventive coverage conditions: Member's plan must include the HSA Preventive Drug coverage feature; benefits are provided in accordance with U.S. Department of the Treasury and IRS guidance for HSAs and qualified High Deductible Health Plans (HDHPs).

Verify the member's specific plan design and employer/group selections; coverage may vary by plan and is subject to change.

Plan verification: Verify whether the member's plan requires a generic to be tried prior to filling a brand product (generic-first).

Consult member benefit materials and the plan website before dispensing; reference brands listed may not be covered.

The list includes reference brand names for some products; reference brands may not themselves be covered. Members and providers should verify the member's benefit to confirm whether a brand product is covered under the plan.

The cited chunks present an alphabetical listing of included drugs and strengths for the high cholesterol category. These chunks do not state any explicit exclusions; they are a listing of included medications and strengths.

Provider and Pharmacy Actions / Verification

Prior Authorization

Plan verification required

Some employer/group plans and all Individual-Under 65 plans may include HSA Preventive Drug coverage. Verify member benefits to confirm HSA preventive coverage, whether a generic-first or step-therapy requirement applies, and any plan-specific edits before ordering or dispensing.

Verify HSA preventive coverage on member's benefit design and plan website
Check whether generic-first or step-therapy is required by the member's plan
Confirm whether listed reference brand drugs are covered under the member's benefit

Documentation Required

Prior authorization not specified

This segment lists medications included on the HSA Preventive Drug List but does not specify prior authorization (PA) or additional documentation requirements. Prior authorization is not specified here — check the member-specific formulary and plan documents for PA details.

No PA details provided in this segment — verify PA requirements per plan
Review member materials or provider portal for up-to-date PA and documentation rules

Step Therapy

Generic-first / Step-therapy may apply

Generic-first (trial of generic before brand) may be required depending on employer/group design. Confirm whether a generic must be tried prior to filling a brand version for the specific member.

Check benefit for generic-first or step-therapy enforcement
Document trials of preferred generics if required for coverage of brand products

Note

Provider action: Not applicable in this segment

Provider action not applicable in this segment: the source content is a medication list and does not include provider-specific billing or prior authorization instructions. Use member benefit verification to determine actionable next steps.

No provider billing actions defined in this segment
Follow plan verification steps to determine if any provider actions are needed

Note

Verify plan-specific coverage

Always refer to the member's benefit materials and the plan website for the most current coverage details and to confirm whether listed medications are covered under HSA preventive benefits for that member.

Refer to employer/group benefit documents and online member portal
Confirm coverage for specific strengths and formulations listed (e.g., ER, micronized, packet forms)

Denial Risk

List-only: PA/documentation not provided

This medication list includes many drugs but does not indicate documentation, quantity limits, or PA criteria. Treat this as an informational list and verify operational rules before prescribing or dispensing to avoid denials.

No quantity limits or documentation requirements provided here — check formulary details
Confirm whether reference brands listed are covered or excluded under the member's plan

Formatting and Generic/Brand Notation

Generic vs Brand notation

Generic drug notationGeneric prescription drugs are shown in lower-case boldface type and most are followed by a reference brand in parentheses.

Brand drug notationBrand prescription drugs are shown in capital letters followed by the generic name.

Reference brand coverage noteReference brands shown in parentheses may not themselves be covered; check the member's benefit for coverage details.

Generic availability noteGeneric medicines are available for many brand-name drugs listed but may not be available in all strengths.

Plan verification reminderVerify with the member's plan if a generic must be tried before filling a brand version and refer to benefit materials for details.

Generic / Brand notation

Explicit formatting rule (generic)Generic Drugs = bold

Explicit formatting rule (brand)Brand Drugs = ALL CAPITAL LETTERS

Contextual exampleHigh cholesterol section lists drugs with brand references in parentheses and states the generic/brand formatting convention.

OpenPayer

HSA Preventive Drug List

Preventive Drug Coverage Criteria

Provider and Pharmacy Actions / Verification

Policy Background

Formatting and Generic/Brand Notation

Step Therapy and Generic-First Requirements