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:
            Axiron
      Antidepressant Drug - Pristiq
      Anti-Fungal Nail Polishes such as:
            Jubila
            Kerydin
            Penlac
      AuviQ
      Brand Sleep Hypnotics such as:
            Belsomra
            Ambien
            Lunesta
      Anti-Hemophiliac Drugs
      Bulk Chemical Powders such as:
            Fentanyl
            Gabapentin
            Ketamine
            Baclofen
      Combo Medications such as:
            Vimovo
            Duexis
      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:
            Gels
            Pastes
            Fluorides (except those covered under the Patient Protection & Affordable Care Act)
      Dermatologicals such as:
            Doxepin 5%
            Prudoxin
            Vanos 0.1%
            Zonolon External Cream Endari
      Durlaza
      Electrolyte Replacement
      Erectile Dysfunction / Impotence Agents in all forms, such as:
            Viagra
            Caverject
      Experimental / Investigational Drugs
      Female Libido Drugs such as:
            Addyi
            Vyleesi
      Gaucher's Disease Medications
      Gralise
      Horizant
      Hysingla
      Infertility Agents (Oral or Injectable)
      Insulin Pumps
            Covered under medical benefits
      Microsomal Triglyceride Transfer Proteins such as:
            Juxtapid
            Kynamro
      Kuvan
      Tobacco Cessation Products in the follow forms:
            E-Cigarettes
            Nasal Sprays
            Inhalers
      Male Condoms
      Miscellaenous Items such as:
            Band-Aids
            Hosiery
            Medical Devices
            Ostomy Supplies
            Splints
            Surgical Supplies
            Wraps
      Multi-Source Brands which have an equivalent generic available such as:
            Abilify
            Benicar
            Celebrex
            Crestor
            Diovan
            Lipitor
            Vytorin
            Zetia
      Nasal Sprays
      Multi-Vitamins such as:
            Mebolic
            Niacor
            Vasculera
            Zyvit
      Xyzbac
      Non-Sedating Antihistamines (Brand Names Only) such as:
            Clarinex
            Xyzal
      Over-The-Counter (OTC) Medications, except those specifically covered
      Parkinson Drugs such as:
            Azilect
            Gocovri
            Osmolex ER (amantadine is covered)
      Passive Immunizing Agents such as:
            Gammagard
            Gamunex
      Proton Pump Inhibitors (Brand Names) such as:
            Dexilant
            Nexium
      Proton Pump Inhibitors (Generics) such as:
            Omeprazole Sodium Bicarbonate
      Restasis
      Weight Loss Medications
      Zohydro
      Yospral