Our drug benefit does not automatically cover every new drug that the U.S. Food and Drug Administration approves. We have a panel of physicians from many different specialties to evaluate new drugs. If an excluded drug has been prescribed for you, ask your physician or pharmacist if he or she can substitute it with one of the medications we cover. Please call Customer Service for an updated list or for more information about your prescription drug benefit. The following drugs are not covered by Dean Health Plan.

A
Acarbose (PRECOSE)
Acrivastine/pseudoephedrine (SEMPREX-D)
Alefacept (AMEVIVE)
ALESSE
Alosetron (LOTRONEX)
Appetite suppressants
APRI
Ardeparin (NORMIFLO)
AVIANE
Azelastine HCl ophthalmic solution (OPTIVAR)

B
Bepridil (VASCOR)
Bitolterol inhaler (TORNALATE)
BRONTEX (guaifenesin/codeine)
Butorphanol nasal spray (STADOL NS)

C
Candesartan (ATACAND)
Cefaclor
Cefixime tablets (SUPRAX)
Ceftibuten (CEDAX)
CENESTIN (synthetic conjugated estrogens)
Cephradine
Cetirizine/pseudoephedrine (ZYRTEC D)
Ciclopirox (PENLAC)
Ciprofloxacin/dexamethasone otic solution (CIPRO HC)
Clindamycin/benzoyl peroxide gel 1-5% (BENZACLIN) 50 mg
Colesevelam (WELCHOL)
Colestipol (COLESTID)
COVERA-HS
CYCLESSA

D
D.A. II
Dalteparin (FRAGMIN)
Desloratadine (CLARINEX)
Dexamethasone inhaler (DECADRON TURBINAIRE)
Diclofenac/misoprostol (ARTHROTEC)
Diclofenac potassium (CATAFLAM)
Diltiazem HCI (CARDIZEM CD)
Diltiazem SR (DILACOR XR, TIAZAC)
Dipyridamole/aspirin (AGGRENOX)
Dirithromycin (DYNABAC)
DYAZIDE

E
Eflornithine (VANIQA)
Eletriptan (RELPAX)
Emadastine diflumarate (EMADINE)
Enalapril/felodipine (LEXXEL)
Enoxacin (PENETREX)
Eprosartan (TEVETEN, TEVETEN HCT)
ESKALITH CR
Esomeprazole magnesium (NEXIUM)
ESTRADERM
Estradiol topical emulsion (Estrasorb)

F
Famciclovir (FAMVIR)
Famotidine (PEPCID) except generic 20 mg and 40 mg tablets and oral suspension
Felodipine (PLENDIL)
Fenofibrate (TRICOR)
Fexofenadine/pseudoephedrine (ALLEGRA D)
Flunisolide nasal inhaler (NASALIDE, NASAREL)
Flunisolide oral inhaler (AEROBID, AEROBID-M)
Flurbiprofen (ANSAID)
Fondaparinux sodium (ARISTRA)
Fosfomycin (MONUROL)
Fosinopril (MONOPRIL)
Frovatriptan (FROVA)

G
Gatifloxacin (TEQUIN)
Gatifloxacin ophthalmic solution (ZYMAR)
GLUCOVANCE

H
HELIDAC
Human growth hormone brands other than Humatrope (Humatrope requires prior authorization)
Hydrocodone/ibuprofen (VICOPROFEN)
Hydroquinone products

I
Ibuprofen/hydrocodone (VICOPROFEN)
Irbesartan (AVAPRO)
Irbesartan HCT (AVALIDE)
Isoproterenol inhaler (MEDIHALER-ISO or ISUPREL)
Isosorbide mononitrate (ISMO)
Isradipine (DYNACIRC CR)

K
KADIAN
Ketotifen fumarate ophthalmic solution (ZADITOR)

L
Lansoprazole (PREVACID)
Levalbuterol (XOPENEX)
Levonorgestrel ethinyl estradiol (NORDETTE)
LEVORA
LITHOBID
LOESTRIN, LOESTRIN FE
Lomefloxacin (MAXAQUIN)
LO-OVRAL
Loracarbef capsules (LORABID)
Loratadine prescription products (OTC tablets, melting tablets and syrup are covered)
Loratadine pseudoephedrine (CLARITIN D) OTC and prescription

M
Mefenamic acid (PONSTEL)
METADATE CD
Metaproterenol inhaler (ALUPENT INHALER)
Minoxidil topical solution (ROGAINE)

N
Naphazoline/antazoline ophthalmic solution
Naphazoline HCl/pheniramine maleate ophthalmic solution
NAPRELAN
NAPROSYN EC
NECON
Nicardipine (CARDENE and CARDENE SR)
Nifedipine (PROCARDIA XL)
Nisoldipine (SULAR)
Norfloxacin (NOROXIN)
NORINYL
NOR Q-D

O
OGESTREL
Orlistat (XENICAL)
OVCON
Over-the-counter drugs
OVRAL

P
Pemirolast potassium ophthalmic solution (ALAMAST)
Phenylpropanolamine-containing products
Phenytoin (all generics)
Pravastatin (PRAVACHOL)
PREFEST
PRILOSEC (OTC is covered)
Progesterone oral (other than PROMETRIUM)
PROPECIA

Q
Quinapril (ACCUPRIL)

R
Ramipril (ALTACE)
Ranitidine capsules (ZANTAC)

S
Sildenafil (VIAGRA)
Smoking-cessation products (Zyban and the OTC nicotine patch are covered)
Sparfloxacin (ZAGAM)

T
Tacrine (COGNEX)
Tadalafil (CIALIS)
Telmisartan (MICARDIS)
Telmisartan HCT (MICARDIS HCT)
Terbutaline inhaler (BRETHAIRE)
Testosterone patch (ANDRODERM)
Tiludronate (SKELID)
Tinzaparin (INNOHEP)
Tolmetin (TOLECTIN)
Tolterodine (DETROL, DETROL LA)
Toremifene (FARESTON)
Torsemide (DEMADEX)
Trandolapril (MAVIK)
Trandolapril/verapamil (TARKA)
Triamcinolone nasal inhaler (NASACORT, NASACORT AQ)
TRI-NORINYL
TRIPHASIL
Trospium chloride (SANCTURA)
Trovafloxacin (TROVAN)

U
UNIVASC
Unoprostone isopropyl (RESCULA)

V
Valdecoxib (BEXTRA)
Vardenafil (LEVITRA)
VERELAN
VOLTAREN XR

Z
Zafirlukast (ACCOLATE)
Zaleplon (SONATA)
Zanamivir (RELENZA)
Zileuton (ZYFLO)
ZOVIA

Please note: Some members may have coverage for one of these drugs based on an exception in their pharmacy benefit or an authorization from Dean Health Plan.

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