1. Drugs prescribed for cosmetic purposes only;
  2. Drugs available without a prescription, except insulin, diabetic supplies and preventive care items;
  3. Pharmaceuticals requiring a prescription that:
    • Have not been approved by the U.S. Food and Drug Administration (FDA); or
    • Are not approved by the FDA for the condition, dose, route and frequency for which they are prescribed (i.e. are used “off-label”);
  4. Prescription Drugs when there is an equivalent available without a prescription;
  5. Nicotine gum, Anorexiants (appetite suppressants) and anti-obesity medications, or Nystatin oral powder;
  6. Drugs for treatment of infertility;
  7. Medical supplies and equipment where coverage is provided under the Medical Plan Benefit (except syringes and needles for administration of insulin, and other self-administered injectables), and alcohol swabs;
  8. Drugs that were not prescribed by a provider acting within the scope of their license;
  9. Experimental and/or Investigational or unproven Drugs or therapies, or medications with no FDA indications;
  10. Drugs furnished to you by the local, state or federal government and any Drug to the extent payment or benefits are provided from the local, state or federal government, whether or not the payment or benefits are received, except as otherwise provided by law;
  11. Prescription vitamins, except prenatal vitamins, vitamins used for indications other than nutritional supplementation, and preventive care items;
  12. Any replacement of a Prescription Drug resulting from loss or theft.