Let's Talk Prevention — No-Cost Preventive Services Coverage Criteria
Customize your policy alerts
Sign up for all healthchoiceofoklahoma policy alerts
Know when healthchoiceofoklahoma releases new policies or updates existing guidance.
Monitor payer policy activity
Lists preventive medicines, supplements, vaccines and products covered at no cost under HealthChoice of Oklahoma plans and who they apply to (adults, women, children). Intended for providers, pharmacists and members to identify covered preventive services.
No material clinical or coverage changes in this revision.
Covered Preventive Services & Eligibility
Covered preventive interventions with age/risk criteria
Covered preventive services when member meets the listed age or risk criteria:
See source for listed OTC aspirin products.
See source for age/pregnancy requirement and listed OTC aspirin products.
See source for specific sodium fluoride strengths and forms.
See source for population definition.
See source for included products and Zyban exclusion.
See source for general vaccine coverage statement.
See source for colonoscopy screening age range and bowel prep coverage.
See source for specific statin agents and strengths.
Breast Cancer Primary Prevention Criteria
Covered when ALL of the following apply
Source specifies primary prevention in women 35 years and older or members at increased risk.
Source indicates primary prevention is for those at increased risk.
See source for listed agents and strengths.
Optional Medication-Assisted Treatment (MAT) Criteria
Covered as an optional preventive service when used as part of comprehensive treatment
Source frames MAT to help people dependent on opioid drugs.
Source specifies the comprehensive program requirement.
See source for specific MAT products and strengths.
Other rules, limits, and exclusions may apply to the preventive services listed. The plan provides certain preventive medicines, supplements, vaccines and products at no cost under the ACA, but coverage details can vary by product and plan. Generics are presented in italics and brand names in CAPITALS, and brand-name products will no longer be supplied at no cost when a generic becomes available. Providers and pharmacists should verify plan-specific limits and supply rules before dispensing.
Some strengths or dosage forms may be excluded from the HDHP‑HSA Preventive Therapy Drug List. Certain products or categories may not be covered regardless of their appearance in this document, so check the member's prescription benefit plan and the HDHP‑HSA Preventive Therapy Drug List for plan-level exclusions or differences in covered forms and strengths.
Zyban (brand‑name bupropion) is specifically noted as NOT covered. The policy includes coverage for generic bupropion but explicitly excludes the Zyban brand for tobacco cessation.
Drug Lists & Codes
| Atorvastatin 10 mg, 20 mg | generic low to moderate intensity statin |
| Fluvastatin 20 mg, 40 mg | generic low to moderate intensity statin |
| Fluvastatin ER 80 mg | generic low to moderate intensity statin |
| Lovastatin 10 mg, 20 mg, 40 mg | generic low to moderate intensity statin |
| Pravastatin 10 mg, 20 mg, 40 mg, 80 mg | generic low to moderate intensity statin |
| Rosuvastatin 5 mg, 10 mg | generic low to moderate intensity statin |
| Simvastatin 5 mg, 10 mg, 20 mg, 40 mg | generic low to moderate intensity statin |
| Multiple brand and generic oral contraceptives and equivalents | Extensive list of brand-name products and generic equivalents for women's health preventive services (examples include Alesse, Loestrin, Ortho Tri-Cyclen, Yasmin, etc.) |
| Other contraceptives (Diaphragms, cervical caps, emergency contraception, patches, injectables, condoms, sponge, spermicides) | List includes devices and OTC/Rx emergency contraception products such as ELLA and levonorgestrel tablets (Plan B equivalents). |
| Raloxifene HCl tab 60 mg | breast cancer primary prevention medication (generic, oral) |
| Tamoxifen citrate tab 10 mg and 20 mg | breast cancer primary prevention medication (generic, oral) |
| Buprenorphine sublingual tab 2 mg, 8 mg | medication-assisted treatment product (Rx) |
| Buprenorphine-naloxone sublingual tab 2 mg-0.5 mg, 8 mg-2 mg | medication-assisted treatment product (Rx) |
| Naltrexone tab 50 mg | medication-assisted treatment product (Rx) |
Provider Responsibilities & Verification
No prior authorization listed
No prior authorization requirements are specified in this document for the listed preventive services.
Check member's plan for coverage variability
Some products or dosage forms may not be included on all plan lists (for example, HDHP‑HSA Preventive Therapy Drug List exclusions); verify the member's prescription benefit plan for coverage and prior authorization rules.
- "Some strengths or dosage forms may not be included in the high deductible health plan-health savings account (HDHP-HSA) Preventive Therapy Drug List and certain products or categories may not be covered, regardless of their appearance in this document."
Source note placeholder
Preserved for source notes and flags; no specific provider action text provided in this section of the document.
Generic substitution expectation
When a generic becomes available, the brand-name product "will no longer be supplied at no cost."
Bring lists to visits; prescriptions must be written by a doctor
Advise members to bring these lists to checkups and ensure prescriptions are written by a doctor for coverage; the document instructs members to take the lists to exams and notes a doctor must write the prescription.
- "Take these lists with you each time you or your family has a checkup or yearly exam."
- "Your doctor must write a prescription for these preventive services to be covered by your plan, even if they are listed as over-the-counter."
Verify plan-level coverage
The listed products are informational and do not guarantee coverage; providers must consult the member's plan for complete coverage details.
- "List does not guarantee coverage. Your prescription benefit plan may not cover certain products or categories, regardless of their appearance in this document."
- "Please check with your plan provider should you have any question about coverage."
Prescription required for coverage
A doctor-prescribed order is required for preventive services to be covered, even for items shown as over-the-counter on these lists.
Coverage not guaranteed by appearance on list
Inclusion on these lists does not guarantee coverage under a member's prescription benefit plan; check the member's plan for coverage of specific products or categories.
- "List does not guarantee coverage. Your prescription benefit plan may not cover certain products or categories, regardless of their appearance in this document."
Background & Policy Purpose
This document lists preventive interventions organized by age and risk group to support reduction of disease incidence. It identifies which medicines, supplements, vaccines and prevention-related products are covered at no cost, the populations they apply to (for example, age ranges or pregnancy status), and notes where recommendations, doses, or plan-level coverage may vary.
Definitions & Notes
OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.