What the Plan Does Not Cover
No benefit will be provided for any expense incurred for the following drugs, medicines, substances or supplies rendered, unless specifically listed as a benefit under What the Plan Covers. Ineligible drugs, medicines, substances and supplies include:
  • Drugs, medicines, substances or supplies that are not Medically Necessary (see "Medically Necessary" in "What the Plan Covers");
  • Experimental and investigational drugs;
    • Experimental or investigational drugs are not covered under the Prescription Drug Plan. These drugs are typically new products that are still being tested by the FDA and have not been approved for general distribution under the standard prescription process. Further, drugs that are limited by federal law to investigational use and that are labeled as such are not covered. A drug may also be considered experimental if prescribed for an indication or at a dosage that is not an accepted use based on published reports in standard drug publications such as the American Hospital Formulary Service Drug Information and the United States Pharmacopeia Dispensing Information.
  • Drugs or supplies that may be dispensed without a prescription;
  • Medications not used in accordance with the FDA's approval specifications;
  • Inpatient medications (i.e., drugs dispensed or used while you are a patient in a licensed hospital, rest home, sanitarium, extended care facility, skilled nursing facility, convalescent home, nursing home, or similar institution);
  • Retin-A (unless prescribed for medical treatment other than anti-aging or for individuals under age 26);
  • Smoking deterrents other than those listed under What the Plan Covers;
  • Allergy serums;
  • Therapeutic devices or appliances;
  • Drugs prescribed solely for cosmetic purposes (e.g., Renova) or to promote or stimulate hair growth (e.g., Rogaine);
  • Immunization agents and vaccines;
  • Biologicals, blood, or blood plasma;
  • Charges for the administration or injection of a drug;
  • Any prescription refill in excess of the number specified by the physician, or any refill after one year from the date of the physician's original order;
  • Medications to which you are entitled under any Workers' Compensation or occupational disease law;
  • Medication furnished by any other drug or medical service for which no charge is made to the participant; and
  • Any drug for which benefits are paid under another Company-sponsored health plan or benefit program.