Effective January 1, 2013, AmeriHealth will apply age
restrictions to the corresponding National Drug Codes (NDCs) for Plan B One
Step
® (Levonorgestrel, Next Choice
®). As a
result, Plan B One Step
® and generic versions will not be
covered for women age 17 and older. Claims for women age 17 and older will deny
since Plan B One Step
® is available over the counter without a
prescription, and AmeriHealth prescription drug programs exclude coverage for
drugs dispensed without a prescription. This change will not impact other
emergency contraception options available by prescription, which will continue
to be covered with no cost-sharing as required by the Affordable Care Act. The
requirement to cover contraceptives is effective for plan years on or after
August 1, 2012.*
To verify eligibility, please use the NaviNet
® web portal or
call the Provider Automated System at
1-800-275-2573. For additional information, please contact
your Network Coordinator or Hospital/Ancillary Services Coordinator.
*For members with an AmeriHealth prescription drug plan,
generic prescription oral contraceptives are covered with no cost-sharing at
retail and mail order participating pharmacies. Cost-sharing applies to brand
and non-formulary prescriptions. For customers who are eligible for a temporary
safe harbor, the effective date for contraceptive services is for plan years on
or after August 1, 2013. If a customer is a "religious employer" as defined by
the interim final rules issued by the Departments of Health and Human Services,
Labor, and Treasury, they may be exempt from the requirement of providing
contraceptive coverage in their medical and/or prescription drug plans.
NaviNet® is a registered trademark of
NaviNet, Inc.