Preventive drugs that plans must cover with no cost sharing

On June 27, 2025, the Supreme Court ruled 6-3 in Kennedy v. Braidwood Management¹ that members of the U.S. Preventive Services Task Force are inferior officers whose appointment by the Secretary of Health and Human Services is consistent with the Constitution. The decision left in place the Affordable Care Act rule that most private health plans cover the task force's top-rated recommendations, a list that includes several prescription drugs, with no copay, coinsurance or deductible.

The court's reasoning rested on the Secretary's control over the panel. Task force members' work is "directed and supervised" by the Secretary, the justices held, and his power to remove them at will is a "powerful tool for control." Within a year that power was used. In letters dated May 11, 2026, Secretary Robert F. Kennedy Jr. removed the two physicians who chaired the task force, before their terms ended, according to an AP report summarized by KFF Health News³. On Sept. 17, 2026, HHS announced eight new members⁴, who join the eight still serving.

For anyone with a prescription that falls under one of these recommendations, the rules decide whether the pharmacy rings up $0 or a regular copay. They also leave plans room to steer patients toward particular versions of a drug, much as tiered formularies do for other prescriptions.

Where the no-cost-sharing rule comes from

Section 2713 of the Public Health Service Act, added by the ACA, is carried out by a regulation at 45 CFR 147.130⁵. It says a group health plan, or an insurer selling group or individual coverage, "must not impose any cost-sharing requirements (such as a copayment, coinsurance, or a deductible)" for four sets of preventive services: items with an A or B grade from the task force, vaccines recommended by the CDC's immunization advisory committee and adopted by the CDC director, preventive care for children in guidelines supported by the Health Resources and Services Administration (HRSA), and additional preventive care for women in HRSA-supported guidelines. The women's guidelines are the basis for contraceptive coverage. Because the rule bars deductibles as well as copays, a covered preventive drug is supposed to cost $0 even before a deductible is met, a point that matters most in high-deductible plans.

About 100 million privately insured people get preventive services each year without cost sharing under the requirement, KFF estimated². KFF also notes that it reaches Medicaid expansion programs. Plans that are grandfathered under the ACA are outside it, the regulation says. HealthCare.gov¹⁰ adds a practical limit: the services are generally free "when provided by an in-network medical provider."

Timing follows a fixed rule. A plan must cover a new recommendation for plan years beginning one year after the recommendation is issued, and federal guidance treats a recommendation as issued on the last day of the month it is released, according to a 2021 joint FAQ from the Labor, HHS and Treasury departments⁹. If a recommendation changes during a plan year, coverage generally continues through the end of that plan year. The regulation lets a plan stop sooner only if the item is downgraded to a D grade, is recalled for safety, or is otherwise found by a federal regulator to pose a significant safety concern.

Which drugs are on the A and B list

Most of the task force's A and B recommendations⁶ are screenings and counseling. A handful involve medication. The table lists the drug-related items on the list as published in November 2026, with the grade and the date the task force shows for each.

Source: USPSTF A and B recommendations⁶, accessed November 2026.

Those boundaries are narrow. The 2022 statin recommendation⁷ gives a B grade only to adults 40 to 75 with one or more risk factors (dyslipidemia, diabetes, hypertension or smoking) and an estimated 10-year risk of 10 percent or greater. For a 7.5 percent to 10 percent risk, the grade is C, and for adults 76 and older the task force found the evidence insufficient. Neither of those groups is inside the $0 requirement. The recommendation also does not apply to people who already have cardiovascular disease, or to adults with LDL cholesterol above 190 mg/dL or known familial hypercholesterolemia. A statin prescribed in those situations can carry the plan's ordinary copay. Whether a particular prescription counts as preventive is a question for the prescriber and the plan.

What plans may still do

Plans keep some room. The regulation lets them use "reasonable medical management techniques" to decide the frequency, method, treatment or setting of a preventive item, to the extent the recommendation does not specify them. In practice that is how plans tie $0 coverage to generics.

In the 2021 FAQ, PrEP was the example. Because the recommendation does not name a brand, "plans and issuers may cover a generic version of PrEP without cost sharing and impose cost sharing on an equivalent branded version," the departments wrote. The same FAQ says plans must have an exceptions process that is "easily accessible, transparent, and sufficiently expedient," and must waive cost sharing on the brand or non-preferred version when a patient's provider determines the other one would be medically inappropriate. Plans also may not charge for the HIV testing, other lab work and adherence counseling that the 2023 PrEP recommendation⁸ calls for, and the FAQ says it would not be reasonable to restrict the number of times a person may start PrEP.

Generic supply makes that approach workable. In GxRadar's count of FDA's Drugs@FDA¹² data, 13 approved generic drug applications are on file for the emtricitabine and tenofovir disoproxil fumarate combination used for PrEP, 10 of them with a product still listed as marketed. Atorvastatin has 33, with 24 still marketed. In October 2026, pharmacies paid an average of about 85 cents for 30 tablets of atorvastatin 20 mg, and about $1.07 for 30 tablets of rosuvastatin 10 mg, according to CMS NADAC data¹¹. Our drug pages track the same NADAC histories for simvastatin and pravastatin. A patient whose plan requires a particular version first may run into the processes described in our piece on prior authorization and step therapy.

What the Braidwood case did and did not settle

In the lawsuit, a company that offered coverage through a self-insured plan and other plaintiffs argued that task force members were principal officers who needed presidential appointment and Senate confirmation. A federal district court and the Fifth Circuit ruled for the plaintiffs on that question. The Supreme Court reversed, holding that the Secretary's at-will removal power and his statutory authority to review and block recommendations make the members inferior officers. The PrEP requirement had been at the center of the dispute, KFF noted², since the plaintiffs objected to covering it on religious grounds.

The ruling settled who appoints the panel. It did not settle what the panel will recommend. KFF wrote on the day of the decision that an administration could change the task force's membership "in ways that may significantly alter the recommendations it issues," or ask it to revisit earlier ones. With eight of its 16 current members appointed in September 2026, any change to a drug recommendation would show up first on the task force's A and B list. Under 45 CFR 147.130, a new or expanded recommendation must be covered for plan years that begin a year after it is issued. An item dropped from the list must still be covered through the end of the plan year in progress, unless it is downgraded to D or recalled.