September 2017
No Cost-share Coverage for Statin Use to Help Prevent Cardiovascular Disease in Adults
The United States Preventive Services Task Force (USPSTF) issued a recommendation last November regarding statin use for the primary prevention of cardiovascular disease (CVD) in adults without a history of the disease. Their recommendation is that adults use a low-to-moderate dose statin to prevent CVD if they meet all the following criteria:
- Are between 40-75 years in age
- Have one or more CVD risk factors, such as hypertension, diabetes or smoking
- Have a calculated 10-year risk of 10 percent or higher for experiencing a cardiovascular event
As a result of this recommendation, Blue Cross and Blue Shield of Illinois (BCBSIL) will implement the following changes to statin coverage:
- BCBSIL will begin covering prescription statins for members between the ages of 40-75 without cost-sharing on Dec. 1, 2017, regardless of renewal date
- Prescription statins covered at no cost-share will include Lovastatin (20mg and 40mg) and Pravastatin (10mg, 20mg, 40mg, 80mg)
- -There will be an exception process for members who are unable to take generic medications
- Quantity limits will not be imposed
BCBSIL will issue additional reminders as we get closer to the December deadline.
The information mentioned here is for informational purposes only and is not a substitute for the independent medical judgment of a physician. Physicians are to exercise their own medical judgment. Pharmacy benefits and limits are subject to the terms set forth in the member’s certificate of coverage which may vary from the limits set forth above. This is only a brief summary of some plan benefits. For more complete details, including benefits, limitations and exclusions, members should refer to their certificate of coverage. Regardless of benefits, the final decision about any medication and pharmacy choice is between the member and their health care provider.