The United States Preventive Services Task Force (USPSTF) has revised its preventive recommendation for cholesterol screening and now includes cholesterol screening as a part of its new recommendation for statin use for the primary prevention of cardiovascular disease in adults, narrowing the age range and removing a number of restrictions. This change will go into effect for UnitedHealthcare standard plans on Dec. 1, 2017.
Screening for Adults
- Screening members aged 40 to 75 ending on 76th birthday.
- Fewer diagnosis codes will be required with specific screening codes.
- USPSTF Rating: B.
Statin Use for the primary prevention of cardiovascular disease in adults – Effective Dec. 1, 2017 (May 15, 2017 in N.Y.)
The USPSTF recommends that adults without a history of cardiovascular disease use low- to moderate-dose statins for primary prevention of cardiovascular disease when certain risk factors are identified. As a result, some statins will become available at $0 cost-share for members who meet all of the following criteria and do not have a history of cardiovascular disease:
- Are between the ages of 40-75.
- Have one or more cardiovascular risk factors, such as dyslipidemia, diabetes, hypertension or smoking.
- Have a calculated 10-year risk of a cardiovascular event of 10 percent or greater.
This coverage will become available on Dec. 1, 2017, for most fully insured and self-funded groups that have standard health reform preventive coverage.
Not all statins will be covered at zero cost-share. Prior authorization will be required (with exception of lovastatin) to ensure that the member is using the medication for primary prevention of cardiovascular disease and has the noted risk factors. For members who do not go through prior authorization, statins will continue to be covered at their current tier.
For questions, please contact your UnitedHealthcare representative.