Page 21 - Takoma Park Benefits Guide 2022

■ Contraceptive ring (P) ■ Perinatal depression screening and counseling
■ Diaphragm (P) with spermicide (OTC) ■ Preventive drugs for adults
1
■ Female condom (OTC) ■ Aspirin (81mg) (OTC )
■ IUD (inserted by doctor) ■ Colon Preparations–age 50–74 (P)
■ Morning after pill (generic only) (OTC) ■ Folic Acid—women of childbearing age (P)
1
■ Oral contraceptive (brand name (P) only ■ Smoking Cessation (OTC )
when generic equivalent drug is medically ■ Vitamin D (600IU–800IU)—age 65 years and
inappropriate, as determined by the older (P)
individual’s health care provider).
Preauthorization and medical review of ■ Statins (generic low to moderate intensity)—
brand name oral contraceptives is required. adults age 40 to 75 (P)
■ Oral contraceptive (generics) (P) ■ Generic Truvada (emtricitabine/tenofovir
disoproxil fumarate) (brand name (P) only
3
■ Shot/injection (generic only) (P) when generic equivalent drug is medically
■ Spermicide (OTC) inappropriate, as determined by the
■ Sponge (OTC) with spermicide (OTC) individual’s health care provider) including
medication monitoring, preventive counseling
■ Sterilization implant
or office visits which may include the
■ Sterilization surgery following services:
■ Prenatal care ■ Adherence counseling
■ Routine prenatal obstetrical office visits Creatinine testing
■
■ Lactation consultations which may include ■ HIV, Hepatitis B and Hepatitis C screenings
comprehensive breastfeeding education, Pregnancy testing
support, counseling, clinical management ■
and interventions provided to women during ■ STI screening & counseling
the antenatal, perinatal, and postpartum ■ Preventive drugs for children
period to support the initiation, maintenance ■ Fluoride—preschool age (P)
and continuation of breastfeeding, including Iron—6–12 mo. risk of anemia (OTC )
1
when provided to women who encounter ■
difficulties breastfeeding due to anatomic
variations, complications, and feeding
problems with newborns.

Additional information on preventive services is available
at healthcare.gov/coverage/preventive-care-benefits

To verify your benefits, check your benefits contract, your enrollment materials or
log into My Account at carefirst.com/myaccount.

1 Requires a prescription from a physician and must be purchased at a pharmacy to obtain the zero-cost share.
2 Prescriptions must be purchased at a network pharmacy to obtain the zero-cost share. Members may be able to receive up to a 12-month
supply of prescription contraceptives. Requires a prescription from a physician, or from a Maryland or D.C. board-certified network
pharmacist, for the contraceptive(s). For Maryland members, a prescription is not required for certain OTC emergency contraceptives. Ask
your pharmacist if you have any questions regarding dispensing amount.
3 Includes brand name Depo-SubQ Provera 104 (injection) (P) Prescription Required (OTC) Over the Counter

CareFirst BlueCross BlueShield is the shared business name of CareFirst of Maryland, Inc. and Group Hospitalization and Medical Services, Inc., which are independent licensees
of the Blue Cross and Blue Shield Association. BLUE CROSS ® , BLUE SHIELD ® and the Cross and Shield Symbols are registered service marks of the Blue Cross and Blue Shield
Association, an association of independent Blue Cross and Blue Shield Plans.
CST2178-1P (2/22)