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
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-ostomy and irrigation supplies, other Rx devices)	Not covered
Select Medical Devices and Artificial Saliva products	Not Covered
Toxoids	Not covered (seasonal and non-seasonal vaccines, including flu and COVID-19 vaccines, 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®.