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Retiree Medical, Prescription Drug and Mental Health and Substance Abuse Programs - RR Donnelley   
How the Prescription Drug Program Works
What Expense Is Excluded From Being a Covered Expense – Prescription Drug Program
Charges for the following drugs or medicines by way of example, but not of limitation, are not covered under the Prescription Drug Program. The claims administrator will make a final determination as to whether an expense is excluded from being a covered expense.
 | Drugs prescribed for cosmetic purposes only (e.g., topical minoxidil, Rogaine®, etc.).
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| Drugs available without a prescription, except insulin.
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| Prescription drugs, when there is an over-the-counter equivalent available without a prescription.
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| Prescription drugs that are not prescribed by a properly licensed physician who is acting within the scope of his or her license.
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| Over-the-counter smoking cessation products, including nicotine gum and patches. (Prescription smoking cessation products are covered up to a dollar limitation. Once the dollar limitation is met, these services are no longer covered.)
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| Infertility medications.
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| Appetite suppressants (excluding Dexedrine® and Desoxyn®, which are covered with a prior authorization issued by the claims administrator).
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| Weight loss medication, unless prior authorization is issued by the claims administrator.
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| Nail fungal treatment, unless prior authorization is issued by the claims administrator.
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| Medical supplies and equipment (except syringes and needles for the administration of insulin, alcohol swabs, lancets, and devices).
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| Experimental, investigational, or unproven drugs or therapies as defined by the FDA.
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| Replacement prescription drugs that result from loss or theft.
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| Medications with no approved FDA indications.
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| Compound prescription medications that do not contain at least one covered legend drug.
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| Charges to the extent that you or your spouse is in any way paid or entitled to payment for those expenses by or through a public program (other than Medicaid).
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| Charges to the extent that payment is unlawful where you or your spouse resides.
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| Charges you or your spouse incurs related to an injury or disease that is covered by Workers’ Compensation or similar law.
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| Charges that you or your spouse is not legally required to pay.
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| Charges you or your spouse incurs before the coverage effective date.
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| Charges in connection with a mental illness or injury that is due to a declared or undeclared act of war, including armed aggression.
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| Any “service” charge. |
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