Making Healthy Cheaper
Rx - Exclusions

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.

      Rx Exclusions  

Use the following links to access the Express Scripts (ESI) Formulary for each health coverage option:


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