Changes to Coverage of Oral-Combined Contraceptives Due to Wide Range of Generic Alternatives:

Horizon Blue Cross Blue Shield of New Jersey manages pharmacy benefits to encourage the safe and
appropriate use of prescription medicines. We are changing the way that we provide coverage for brand
name, oral-combined contraceptive pills.

Starting June 15, 2018, brand name, oral-combined contraceptive pills will no longer be covered at a
$0 copayment. This change is due to the wide range of generic alternatives that are available in various
dosage forms and strengths for contraception. These brand name contraceptives will continue to be covered
under a member’s pharmacy benefit, but a corresponding copayment or coinsurance amount will apply based
on the member’s pharmacy plan design.

Below are examples of commonly prescribed brand name, oral-combined contraceptive pills that will have
the appropriate copayment or coinsurance applied to them:

Examples of brand name, oral-combined contraceptive pills:

• Estrostep Fe
• Lo Loestrin Fe
• Loestrin 1/20-21
• Loestrin Fe 1.5/30
• Loestrin Fe 1/20
• LoSeasonique
• Minastrin 24 Fe
• Mircette
• Ortho Micronor
• Ortho Tri-Cyclen
• Ortho Tri-Cyclen Lo
• Ortho-Cyclen
• Ortho-Novum 1/35
• Ortho-Novum 7/7/7
• Seasonique
• Taytulla
• Tri-Norinyl 28
• Yasmin 28
• Yaz

Horizon BCBSNJ will continue to cover generic, oral-combined contraceptive pills at a $0 copayment.

Cosmo Insurance Agency is an independent insurance agency serving surrounding communities in New Jersey. Cosmo keeps its promise to assure an efficient and creative approach to the services we offer. Each of our clients experience a personalized and long-term relationship with us. Our New Jersey based team of health brokers guides our clients in helping them choose the most cost-effective options. By incorporating the latest in technology-based tools and laws on healthcare, employee benefits, life insurance and finance, we keep our clients up-to-date with the plans that encompass all of their needs, whether it is individual or group insurance.

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