Declinable Prescription Drugs

Many prescription drugs are not limited to the treatment of just one condition (For example, the use of Albuterol for asthma would be acceptable but declinable if used for COPD). If you are taking one of these medications for the specific declinable condition listed, you will not be eligible for coverage. This list is not all inclusive.


Medical conditions and declinable drugs


Abilify

For schizophrenia or bipolar disorder


Abatacept

For rheumatoid arthritis (injection)


Actemra

For rheumatoid arthritis (injection)


Advair Diskus

For chronic bronchitis or COPD


Albiglutide

For diabetes (injection/non-insulin)


Albuterol

For COPD


Alirocumab

For cholesterol (injection)


Amiodarone

For ventricular arrhythmia


Antabuse

For alcoholism


Apriso 

For ulcerative colitis


Arava

For rheumatoid arthritis


Aricept

For Alzheimer's disease or memory loss


Aripiprazole

For schizophrenia or bipolar disorder


Asacol

For ulcerative colitis


Atrovent

For COPD


Auranofin

For rheumatoid arthritis


Avonex

For multiple sclerosis


Azathioprine

For prevent kidney transplant rejection or rheumatoid arthritis


Azulfidine

For ulcerative colitis or rheumatoid arthritis


Balsalazide Disodium

For ulcerative colitis or Crohn’s disease


Benztropine

For Parkinson’s disease


Breo

For COPD


Budesonide (oral)

For ulcerative colitis or Crohn’s disease


Bydureon

For diabetes (injection/non-insulin)


Byetta

For diabetes (injection/non-insulin)


Carbidopa

For Parkinson’s disease


CellCept

For transplant anti-rejection or lupus


Chlordiazepoxide

For alcoholism


Chlorpromazine

For schizophrenia or manic depression


Ciclosporin

For organ transplant rejection, rheumatoid arthritis, psoriasis, or nephrotic syndrome


Cilostazol

For intermittent claudication or peripheral vascular disease


Colazal

For ulcerative colitis or Crohn’s disease


Clozapine

For schizophrenia


Clozaril

For schizophrenia


Cogentin

For Parkinson’s disease


Cognex

For Alzheimer’s disease


Combivent

For COPD


Comtan

For Parkinson’s disease


Copaxone

For multiple sclerosis (injection)


Cordarone

For ventricular arrhythmia or tachycardia


Cosentyx

For plaque psoriasis (injection)


Cyclosporine

For organ transplant rejection, rheumatoid arthritis, psoriasis, or nephrotic syndrome


Delzicol

For ulcerative colitis or Crohn’s disease


Depakote

For bipolar disorder


Dilaudid

For severe pain


Donepezil

For Alzheimer’s disease or memory loss


Dulaglutide

For diabetes (injection/non-insulin)


Enbrel

For rheumatoid arthritis, plaque psoriasis, or ankylosing spondylitis (injection)


Entacapone

For Parkinson’s disease


Entresto

For chronic heart failure


Evolocumab

For cholesterol (injection)


Exalgo

For severe pain


Exelon

For dementia or Alzheimer's disease


Exenatide

For diabetes (injection/non-insulin)


Extavia

For multiple sclerosis


Fentanyl

For severe pain


Fluphenazine

For schizophrenia or psychosis


Galantamine

For Alzheimer's disease or dementia


Gengraf

To prevent organ transplant rejection, rheumatoid arthritis, or psoriasis


Geodon

For schizophrenia or bipolar disorder


Giazo

For ulcerative colitis or Crohn’s disease


Gleevec

For leukemia


Haldol

For mood disorders or schizophrenia


Harvoni

For hepatitis C


Heparin

For prevent blood clots (injection)


Humalog

For diabetes (insulin)


Humira

For Crohn's disease, ulcerative colitis, psoriasis, or rheumatoid arthritis (injection)


Humulin

For diabetes (insulin)


Hydrea

For sickle cell anemia, cancer, or blood disorders


Hydromorphone

For severe pain


Hydroxychloroquine

For rheumatoid arthritis or lupus


Hydroxyurea

For sickle cell anemia, cancer, or blood disorders


Imuran

For prevent kidney transplant rejection or rheumatoid arthritis


Infliximab

For rheumatoid arthritis, ulcerative colitis, or Crohn's disease


Interferon

For multiple sclerosis or hepatitis C


Ipratropium

For COPD


Lamictal

For bipolar disorder


Lantus

For diabetes (insulin)


Latuda

For bipolar disorder or schizophrenia


Leflunomide

For rheumatoid arthritis


Levemir

For diabetes (insulin)


Levodopa

For Parkinson’s disease


Lialda

For ulcerative colitis


Librium

For alcoholism


Lithium

For manic depressive disorder or bipolar disorder


Lodosyn

For Parkinson’s disease


Loxitane

For schizophrenia


Lupron

For prostate CA (injection)


Lurasidone

For bipolar disorder or schizophrenia


Maraviroc

For HIV


Mellaril

For schizophrenia


Memantine

For dementia or Alzheimer’s disease


Mercaptopurine

For acute lymphocytic and chronic myeloid leukemia, ulcerative colitis, or Crohn’s disease


Mesalamine

For ulcerative colitis


Methadone

For severe pain


Methotrexate

For cancer or rheumatoid arthritis


Mirapex

For Parkinson’s disease


Morphine

For severe pain


Mycophenolate

For transplant anti-rejection or lupus


Naloxone Buprenorphine

For opioid addiction


Namenda

For dementia or Alzheimer’s disease


Navane

For schizophrenia


Neoral 

For prevent organ transplant rejection or rheumatoid arthritis


Nexterone

For ventricular arrhythmia


Nitro patch

For angina or chest pain (OK if filled and carried as preventative)


Nitroglycerin

For angina or chest pain (OK if filled and carried as preventative)


Nitrolingual spray

For angina or chest pain (OK if filled and carried as preventative)


Nitrostat

For angina or chest pain (OK if filled and carried as preventative)


Novolin

For diabetes (insulin)


Novolog

For diabetes (insulin)


Olanzapine

For schizophrenia or bipolar disorder


Orencia

For rheumatoid arthritis injectable


Otezla

For plaque psoriasis


Pacerone

For ventricular arrhythmia


Palladone

For severe pain


Peg-Intron

For hepatitis C (injection)


Pentoxifylline

For intermittent claudication


Permax

For Parkinson’s disease


Perphenazine

For schizophrenia


Plaquenil

For rheumatoid arthritis or lupus


Pletal

For intermittent claudication or peripheral vascular disease


Praluent

For cholesterol (injection)


Pramipexole

For Parkinson’s disease


Prednisone

For ulcerative colitis or immune and lung disorders


Proair

For COPD


Procrit

For anemia with renal failure, HIV, or cancer


Prograf

To prevent organ transplant rejection


Prolixin

For schizophrenia or psychosis


Pulmicort

For COPD


Purinethol

For acute lymphocytic leukemia, ulcerative colitis, or Crohn’s disease


Quetiapine

For bipolar disorder or schizophrenia


Ranexa

For chronic angina


Ranolazine

For chronic angina


Razadyne

For Alzheimer’s disease or dementia


Rebif

For multiple sclerosis


Remicade

For rheumatoid arthritis, ulcerative colitis, or Crohn's Disease (injection)


Reminyl

For Alzheimer’s disease or dementia


Remodulin

For pulmonary hypertension


Repatha

For cholesterol (injection)


Requip

For Parkinson’s disease


Rheumatrex

For cancer or rheumatoid arthritis


Ridaura

For rheumatoid arthritis


Rilutek

For amyotrophic lateral sclerosis 


Riluzole

For amyotrophic lateral sclerosis


Risperdal

For schizophrenia or bipolar disorder


Risperidone

For schizophrenia or bipolar disorder


Rivastigmine

For Alzheimer’s disease or dementia


Ropinirole

For Parkinson’s disease


Sacubitril/Valsartan

For chronic heart failure


Secukinumab

For plaque psoriasis (injection)


Selegiline

For depression or Parkinson’s disease


Seroquel

For schizophrenia, bipolar disorder, or major depression


Sinemet

For Parkinson’s disease


Spiriva

For COPD


Stelara

For plaque psoriasis (injection)


Suboxone

For opioid addiction


Sulfasalazine

For ulcerative colitis or rheumatoid arthritis


Sulfazine

For ulcerative colitis or rheumatoid arthritis


Symbicort

For COPD


Tacrine

For Alzheimer’s disease


Tacrolimus

To prevent organ transplant rejection


Tanzeum

For diabetes (injection/non-insulin)


Tasmar

For Parkinson’s disease


Tegretol

For bipolar disorder


Thorazine

For schizophrenia or manic depression


Tocilizumab

For rheumatoid arthritis (injection)


Tolcapone

For Parkinson’s disease


Toujeo

For diabetes (insulin)


Trental

For intermittent claudication


Trexall

For cancer or rheumatoid arthritis


Trulicity

For diabetes (injection/non-insulin)


Ustekinumab

For plaque psoriasis (injection)


Victoza

For diabetes (injection/non-insulin)


Xopenex

For COPD


Ziprasidone

For schizophrenia or bipolar disorder


Zyprexa

For schizophrenia or bipolar disorder