Statins Recommended for Certain Adults

Non-grandfathered plans are required to provide 100 percent coverage for some statins for individuals who meet certain criteria, beginning Nov. 15, 2017.

Last year, the U.S. Preventive Services Task Force (USPSTF) recommended that adults without a history of cardiovascular disease (such as coronary artery disease or stroke) use a low- to moderate-dose statin to prevent heart disease and mortality when the following criteria are met:

  1. the adult is age 40 to 75 years;
  2. has one or more cardiovascular risk factors (such as high cholesterol, diabetes, high blood pressure or smoking); and
  3. has a calculated 10-year risk of a cardiovascular event of 10% or greater.

A non-grandfathered plan is required to provide 100 percent coverage for an in-network preventive service beginning with the plan year that begins one year after the date the USPSTF recommendation was issued. USPSTF issued the statin recommendation on Nov. 15, 2016.

For more information on preventive health, follow this link.