ACA News: Preventive coverage will now include statins

Anthem is updating its ACA preventive care coverage to include generic low-to-moderate dose statins due to the US Preventive Services Task Force recommendation regarding Statin Use for the Primary Prevention of Cardiovascular Disease in Adults. This coverage is effective for December 1, 2017.

Anthem will cover generic low-to-moderate dose statins at 100%, no member cost share for members between the ages of 40-75 years old who have one of the following cardiovascular disease (CVD) risk factors: diabetes, hypertension, dyslipidemia and/or smoking. Risk factors will be identified proactively by pharmacy and medical data.

If a member is not proactively identified, the provider can call or fax Anthem’s Prior Authorization Center if they feel that the member meets the age and risk factor criteria and should receive their generic low-to-moderate dose statin at 100% coverage, no member cost share.

Below is a list of generic low-to-moderate dose statins:

  • Atorvastatin 10 – 20mg
  • Fluvastatin IR and XL 20 – 80mg
  • Lovastatin 10 – 40mg
  • Pravastatin 10 – 80mg
  • Simvastatin 5 – 40mg
  • Rosuvastatin 5 – 10mg