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 for 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 | B | C | D | E | F | G | H | I | K | L | M | N | O | P | Q | R | S | T | U | V | Z ]
A
Acarbose (PRECOSE)
Acrivastine/
pseudoephedrine
(SEMPREX-D)
Albuterol inhalers (generic)
Alosetron (LOTRONEX)
Ardeparin (NORMIFLO)
Appetite suppressants
Azelastine hydrochloride
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)
Celicoxib (CELEBREX)
CENESTIN (synthetic
conjugated estrogens)
Cephradine
CLIMARA patch
COVERA-HS
D
D.A. II
Dalteparin (FRAGMIN)
Dexamethasone inhaler
(DECADRON TURBINAIRE)
Diclofenac/Misoprostol
(ARTHROTEC)
Diclofenac potassium
(CATAFLAM)
Diflunisol
Diltiazem HCI
(CARDIZEM CD)
Diltiazem SR (DILACOR XR)
Dirithromycin (DYNABAC)
DYAZIDE
E
EC-NAPROSYN or
NAPRELAN
Eflornithine (VANIQA)
Emadastine diflumarate
(EMADINE)
Enalapril/felodipine (LEXXEL)
Enoxacin (PENETREX)
Estradiol/norethindrone
transdermal system
(COMBIPATCH)
Ethinyl estradiol/noreth AC
(FemHRT)
Ethynodiol-mestranol
(OVULEN)
Etodolac
F
Famciclovir (FAMVIR)
Famotidine (PEPCID) except
generic 20 mg and 40 mg
tablets
Fenofibrate (LIPIDIL)
Fenoprofen
Fexofenadine hydrochloride
(ALLEGRA)
Fexofenadine/
pseudoephedrine
(ALLEGRA D)
Flunisolide nasal inhaler
(NASALIDE, NASAREL)
Flunisolide oral inhaler
(AEROBID, AEROBID-M)
Flurbiprofen
Fluticasone nasal inhaler
(FLONASE AQ)
Fosfomycin (MONUROL)
Fosinopril (MONOPRIL)
G
Gatifloxacin (TEQUIN)
H
HELIDAC
I
Ibuprofen/hydrocodone
(VICOPROFEN)
Irbesartan (AVAPRO)
Isoproterenol inhaler
(MEDIHALER-ISO or
ISUPREL)
Isosorbide mononitrate (ISMO)
Isradipine (DYNACIRC CR)
K
Ketoprofen
Ketotifen fumarate
ophthalmic solution
(ZADITOR)
L
Levalbuterol (XOPENEX)
Levofloxacin (LEVAQUIN)
LODINE XL
Lomefloxacin (MAXAQUIN)
Loracarbef capsules
(LORABID)
Loratadine melting tablets
(CLARITIN REDITABS)
(Ages > 6)
Lovastatin (MEVACOR)
M
Mefenamic acid (PONSTEL)
Metaproterenol Inhaler
(ALUPENT INHALER)
Minoxidil topical solution
(ROGAINE)
Moxifloxacin (AVELOX)
N
Naphazoline/antazoline
ophthalmic solution
Naphazoline HCL/
pheniramine maleate
ophthalmic solution
Nicardipine (CARDENE and
CARDENE SR)
Nifedipine (PROCARDIA XL)
Nisoldipine (SULAR)
Nizatidine (AXID)
NOVOLIN 70/30
NOVOLIN L
NOVOLIN N
NOVOLIN R
O
Omeprazole (PRILOSEC)
Over-the-counter drugs
Oxaprozin (DAYPRO)
P
Pemirolast potassium
ophthalmic solution
(ALAMAST)
Phenylpropanolamine-containing
products
Phenytoin (all generics)
Pravastatin (PRAVACHOL)
Progesterone—oral (other
than PROMETRIUM,
which requires prior
authorization)
PROPECIA
Q
Quinapril (ACCUPRIL)
R
Rabeprazole (ACIPHEX)
Ramipril (ALTACE)
Ranitidine capsules
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)
Trandolapril (MAVIK)
Trandolapril/verapamil
(TARKA)
Triamcinolone nasal inhaler
(NASACORT)
TRITEC
Troglitazone (REZULIN)
Trovafloxacin (TROVAN)
U
Unoprostone isopropyl
(RESCULA)
V
Verapamil HCl (VERELAN)
VOLTAREN XR
Z
Zaleplon (SONATA)
Zanamivir (RELENZA)
Zileuton (ZYFLO)
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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