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)
Alosetron (LOTRONEX)
Appetite suppressants
APRI
Ardeparin (NORMIFLO)
AVIANE
Azelastine HCl ophthalmic solution (OPTIVAR)

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

C
Candesartan (ATACAND)
Cefaclor
Cefixime tablets (SUPRAX)
Cefprozil tablets (CEFZIL)
Ceftibuten (CEDAX)
Celecoxib (CELEBREX)
CENESTIN (synthetic conjugated estrogens)
Cephradine
Cerivastatin (BAYCOL)
Cetirizine/pseudoephedrine (ZYRTEC D)
Clindamycin/benzoyl peroxide gel 1-5% (BENZACLIN) 50 mg
COVERA-HS
CYCLESSA

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

E
EC-NAPROSYN or NAPRELAN
Eflornithine (VANIQA)
Emadastine diflumarate (EMADINE)
Enalapril/felodipine (LEXXEL)
Enoxacin (PENETREX)
Esomeprazole magnesium (NEXIUM)
Estradiol/norethindrone transdermal system (COMBIPATCH)
Ethinyl estradiol/norethindrone AC (FemHRT)
Ethynodiol-mestranol (OVULEN)
Etodolac

F
Famciclovir (FAMVIR)
Famotidine (PEPCID) except generic 20 mg and 40 mg tablets and oral suspension
Fenofibrate (LIPIDIL)
Fenoprofen
Fexofenadine/pseudoephedrine (ALLEGRA D)
Flunisolide nasal inhaler (NASALIDE, NASAREL)
Flunisolide oral inhaler (AEROBID, AEROBID-M)
Fluoxetine HCl (tablets) (capsules are covered)
Flurbiprofen
Fondaparinux sodium (ARIXTRA)
Fosfomycin (MONUROL)
Fosinopril (MONOPRIL)

G
Gatifloxacin (TEQUIN)
Gatifloxacin ophthalmic solution (ZYMAR)

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

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

J
JENSET-28

K
Ketoprofen
Ketotifen fumarate ophthalmic solution (ZADITOR)

L
Lansoprazole (PREVACID)
Levafloxacin (LEVAQUIN)
Levalbuterol (XOPENEX)
LEVLITE
Levonorgestrel ethinyl estradiol (NORDETTE)
LEVORA
LODINE XL
Lomefloxacin (MAXAQUIN)
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)
Metaproterenol Inhaler (ALUPENT INHALER)
Minoxidil topical solution (ROGAINE)

N
Naphazoline/antazoline ophthalmic solution
Naphazoline HCl/pheniramine maleate ophthalmic solution
NAPROSYN EC
NECON
Nicardipine (CARDENE and CARDENE SR)
Nifedipine (PROCARDIA XL)
Nisoldipine (SULAR)
Nizatidine (AXID)
Norethindrone (LOESTRIN, LOESTRIN FE)
Norethindrone/ethinyl estradiol (BREVICON, NORINYL 1/35, TRI-NORINYL)
Norethindrone/mestranol (NORINYL 1/50)
NOVOLIN 70/30
NOVOLIN L
NOVOLIN N
NOVOLIN R

O
Ogestrel
Omeprazole (PRILOSEC)
Orlistat (XENICAL)
Over-the-counter drugs
Oxaprozin (DAYPRO)

P
Paroxetine CR (PAXIL CR)
Pantoprazole (PROTONIX)
Pemirolast potassium ophthalmic solution (ALAMAST)
Phenylpropanolamine-containing products
Phenytoin (all generics)
Pravastatin (PRAVACHOL)
Progesterone oral (other than PROMETRIUM)
PROPECIA

Q
Quinapril (ACCUPRIL)

R
Ramipril (ALTACE)
Ranitidine capsules (ZANTAC gel dose)

S
Sildenafil (VIAGRA)
Smoking cessation products
Sparfloxacin (ZAGAM)

T
Tacrine (COGNEX)
Telmisartan (MICARDIS)
Terbutaline inhaler (BRETHAIRE)
Tiludronate (SKELID)
Tinzaparin (INNOHEP)
Tolmetin
Toremifene (FARESTON)
Torsemide (DEMADEX)
Tramadol
Trandolapril (MAVIK)
Trandolapril/verapamil (TARKA)
Triamcinolone nasal inhaler (NASACORT, NASACORT AQ)
TRILEVLEN
TRITEC
Troglitazone (REZULIN)
Trovafloxacin (TROVAN)

U
Unoprostone isopropyl (RESCULA)

V
Valdecoxib (BEXTRA)
VERELAN
VOLTAREN XR

Y
YASMIN

Z
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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