Prescription Drugs Not Covered by the Prescription Drug Plan
|
Drug
|
Coverage Status
|
|
Allergy Serums (injectable)
|
Not covered
|
|
Blood Plasma/ Blood Transfusion Agents
|
Not covered
|
|
Botox and Myoblock
|
Not covered — for cosmetic purposes; requires prior authorization for other uses.
|
|
Bulk Powders & Topical Analgesic (compounds)
|
Not covered*
|
|
Cosmetic Products (such as depigmenting agents, hair growth stimulants, hair removal agents)
|
Not covered
|
|
Mifeprex
|
Not covered
|
|
Non-Sedating Antihistamines (NSAs)
(such as Clarinex and Allegra)**
|
Not covered
|
|
Nutritional Supplements (injectable or oral)
|
Not covered
|
|
Over-the-Counter Drugs
|
Not covered (but still may be less expensive than related prescription drugs)
|
|
Renova
|
Not covered
|
|
Rx Devices Other Than Respiratory
(such as elastic bandages and supports, GI-guostomy and irrigation supplies, other Rx devices)
|
Not covered
|
|
Select Medical Devices and Artificial Saliva products
|
Not Covered
|
|
Vaccines/Toxoids
|
Not covered (except seasonal flu and COVID-19 vaccines, which are covered)
|
* Your physician and/or pharmacist may contact CVS Caremark to seek exception approval for specific medical reasons.
** Although non-sedating antihistamine (NSA) drugs are not covered under the Prescription Drug Plan, you can still obtain these and other non-covered prescription drugs (versus the over-the-counter alternative) at discounted prices through Maintenance Choice®. You pay 100% of the discounted price for non-covered drugs obtained through Maintenance Choice®.
