Latest News
Clinical Prior Authorization (CPA)
Prescription Management Program

Certain medications may be exlcuded from coverage under the OPEH&W Health Plan. Just because a medication is excluded under the OPEH&W Health Plan, it does not mean it cannot be filled, only that the OPEH&W Health Plan will not provide any assistance in meeting the cost.

Use the following links to access the Express Scripts (ESI) Formulary for each health coverage option:
   Diamond Link
   Platinum Link
   Gold Link
   Silver Link
   Bronze Link
The OPEH&W Health Plan reserves the right to adjust this list from time to time as required
If in doubt, contact the Health Plan Administration Office to verify whether a covered medication is subject to Exclusion

Excluded Medications:
Acthar Gel
   》Except for Infantile Spasms in Children Aged 2 & Under
Alcohol Swabs
Topical Androgens (Testosterone) such as:
Antidepressant Drug - Pristiq
Anti-Fungal Nail Polishes such as:
Brand Sleep Hypnotics such as:
Anti-Hemophiliac Drugs
Bulk Chemical Powders such as:
Combo Medications such as:
Compounded Pain Kits
Cosmetic Agents such as:
   》Hair Growth
   》Hair Reduction
   》Facial Wrinkle Agents such as Botox
   》Bleaching Agents
   》Melanin Stimulating Agents
Dental Products such as:
   》Fluorides (except those covered under the Patient Protection & Affordable Care Act)
Dermatologicals such as:
   》Doxepin 5%
   》Vanos 0.1%
   》Zonolon External Cream Endari
Electrolyte Replacement
Erectile Dysfunction / Impotence Agents in all forms, such as:
Experimental / Investigational Drugs
Female Libido Drugs such as:
Gaucher's Disease Medications
Infertility Agents (Oral or Injectable)
Insulin Pumps
   》Covered under medical benefits
Microsomal Triglyceride Transfer Proteins such as:
Tobacco Cessation Products in the follow forms:
   》Nasal Sprays
Male Condoms
Miscellaenous Items such as:
   》Medical Devices
   》Ostomy Supplies
   》Surgical Supplies
Multi-Source Brands which have an equivalent generic available such as:
   》Nasal Sprays
Multi-Vitamins such as:
Non-Sedating Antihistamines (Brand Names Only) such as:
Over-The-Counter (OTC) Medications
   》Except those specifically covered
Parkinson Drugs such as:
   》Osmolex ER (amantadine is covered)
Passive Immunizing Agents such as:
Proton Pump Inhibitors (Brand Names) such as:
Proton Pump Inhibitors (Generics) such as:
   》Omeprazole Sodium Bicarbonate
Weight Loss Medications