Pharmacy Plan Principal Limitations and Exclusions
Any drug not required for the treatment or prevention of illness or injury
Allergenic extracts
Devices and artificial appliances
Prescriptions dispensed in a hospital or skilled nursing facility
Drugs for use in connection with drug addiction
Drugs which may be purchased without a prescription (non-legend drugs)
Antibacterial soaps/detergents, shampoos, toothpaste/gels and mouthwash/rinses
Oral contraceptives
Medical drugs used for the treatment of sexual dysfunction
Needles and syringes not prescribed for the administration of a covered drug