Changes affect breast cancer and cardiovascular disease services
UnitedHealthcare (UHC) has made changes to its Preventive Services coverage in screening for breast cancer and screening and medication for cholesterol to help prevent cardiovascular disease.
3-D mammography screening
Effective April 1, UHC began providing coverage for digital breast tomosynthesis (three-dimensional mammography) for breast cancer screening and diagnostic testing. Coverage for diagnostic will now include this service as well as under the medical benefit.
This change applies to fully insured and self-funded groups that follow UHC’s standard preventive coverage. Self-funded groups that choose not to cover 3-D mammography must contact their Bukaty Companies representative to exclude the procedure from their plan documents.
Cholesterol screening and statins
Adults without a history of cardiovascular disease but with certain risk factors are recommended to use low-to-moderate-dose intensity statins as a primary form of prevention.
Statins will be available at $0 cost-share for members who meet all of the following criteria and do not have a history of cardiovascular disease:
- Age 40-75, and
- Have one or more cardiovascular risk factors, such as dyslipidemia, diabetes, hypertension or smoking, and
- Have a calculated 10-year risk of a cardiovascular event of 10 percent or greater
This coverage will become effective December 1, 2017, for all states except New York* and for most fully insured and self-funded groups that have standard preventive coverage.
Affordable Care Act covered statins
Not all statins will be covered at zero cost-share and prior authorization will be required (with the exception of Lovastatin). For members who do not go through prior authorization, statins will continue to be covered at their current tier.
| Statins to be covered at $0 cost-share | |
| No authorization required | Lovastatin (generic Mevacor)- All strengths |
| Prior authorization required |
|
*New York: This change will occur for fully insured and Non-ERISA self-funded groups sitused in New York effective May 15, 2017. This will not apply to New York situs grandfathered plans, unless groups have chosen to offer UnitedHealthcare’s standard health reform preventive coverage.
For questions, please contact your Bukaty Companies benefits consultant at 913.345.0440.
