| Drugs when used for anorexia, weight loss, weight gain |
None |
| Drugs when used to promote fertility |
None |
| Drugs when used for cosmetic purposes or hair growth |
Legend Vitamin A derivatives for members 21 years old when used for cosmetic purposes |
| Drugs when used for the symptomatic relief of cough and colds |
Legend agents when used for the symptomatic relief of cough and colds for members 21 years of age and older |
| Prescription vitamins and mineral products |
Prenatal vitamins for women, fluoride preparations that are not in combination with other vitamins, Carnitor, Folic Acid 1mg, Vitamin B 12 injection, vitamin and mineral products for recipients under 21 years of age |
| Nonprescription drugs (Over-the-Counter) |
Multi- vitamins and multiple vitamins with minerals for members less than 21 years of age; Vitamin E for recipients under 21 years of age with documented medical necessity; Enteric coated aspirin; PEN-X; KLOUT; Ibuprofen suspension for members under 21 years; Diphenhydramine; Insulin; Coenzyme Q for recipients under 21 years of age with documented medical necessity; Urine and blood glucose testing supplies; Generic over-the-counter (OTC) non-sedating antihistamines; Iron; Meclizine; Insulin syringes; H-2 Receptor antagonists, topical antifungals and proton pump inhibitors. |
| Barbiturates |
Seconal, Phenobarbital and Mepbaral |
| Benzodiazepines |
|
| Smoking Cessation |
None |