Capital Health Plan

Exclusions and Limitations - Commercial 2008

Avage
Claritin/Claritin-D/loratadine
Dental Flouride Products
Depigmentation Agents
Drugs for treatment of Onychomycosis
Experimental Drugs
Fertility Drugs
Flumist
Injections (except insulin vials, EpiPen, EpiPen Jr., Glucagon, Heparin, Lovenox)
Over-the-Counter (OTC) Drugs
Pepcid/famotidine 20mg
Prilosec/omeprazole 20mg
Propecia
Renova
Smoking Cessation Products
Vaniqa









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