HSA Preventive Drug List
Your employer has elected to include an HSA Preventive Drug coverage feature with your prescription benefit plan. Below is the list of medications available under your HSA Preventive Drug coverage. The actual cost of the medication will be applied toward the preventive benefit offered by your employer, allowing you to receive coverage even if you have not met your deductible. Benefits will be provided in accordance with U.S. Department of the Treasury and Internal Revenue Service (IRS) guidance with Health Spending Accounts (HSAs) and qualified High Deductible Health Plans (HDHPs). This list will be reviewed periodically and is subject to change.

HSA Preventive Drug List — Effective January 1, 2022
The drugs listed below are grouped into broad categories. Each category includes an alphabetical list of drugs. Please verify with your plan if a generic drug must be tried before filling a brand version of a drug. Please refer to your benefit materials for coverage details and the plan website for current information as this publication is subject to change.
ID: 3160NR-E (NR HSA version)