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Support > Insurance & Reimbursement > Screening & Prevention > Medication for Risk Reduction

Most private insurers cover chemoprevention


Ovarian, Endometrial and Uterine Cancer

Hormonal contraceptives, such as birth control pills or patches, have been shown to lower the risk of ovarian and endometrial/uterine cancer. The Affordable Care Act (ACA) requires most private health insurers to pay for FDA-approved contraceptives with no out-of-pocket costs to the patient.

Similarly, federal law requires insurance coverage of contraceptives for federal employees and their dependent. Some health plans limit coverage to certain brands of pills or generic versions. Your health insurance provider can tell you which types of birth control they pay for. 

Some health insurance plans, including self-funded, short-term and exempt “religious employer” plans, are not required to abide by all of the ACA rules and may have different policies regarding coverage of contraceptives. Still, most insurers cover hormonal contraceptives.

Breast Cancer

Tamoxifen, raloxifene and aromatase inhibitors are FDA-approved medications for breast cancer risk reduction in high-risk women. The Affordable Care Act (ACA) requires most private health plans to pay for these drugs with no out-of-pocket expenses for women ages 35 and older who meet the U.S. Preventive Services Task Force (USPSTF) guidelines.

The law does not apply to women below age 35 and some high-risk women may not be eligible, even if they have an inherited mutation that increases their risk of cancer. In these cases, health insurers generally will cover the medications for high-risk women but deductibles, coinsurance or copays may apply. 

Medications, including statins (typically used to lower cholesterol levels) and aspirin, have been studied for their potential role in reducing the risk of certain cancers, preventing recurrence and/or increasing survival. 

While private insurers may not cover these medications at 100%, they are often available with a minimal copay and the cost may be applied to a Flexible Spending (FSA) or Health Spending Account (HSA).

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