Medication to lower cancer risk for certain women

The Patient Protection and Affordable Care Act (ACA) requires most health insurance plans to pay for “chemoprevention counseling” and if appropriate, medications that reduce a woman's risk of cancer such as tamoxifen or raloxifene, or aromatase inhibitors. These medications must be covered at 100%, with no out-of-pocket costs for women ages 35 and older who meet the U.S. Preventive Services Task Force (USPSTF) guidelines. However, the law does not apply to women under the age of 35 and some high-risk women may not be eligible for 100% coverage.

Note that the ACA does not apply to Medicare or Medicaid. They have their own rules. See the Insurance & Reimbursement section of our website to learn more.