These prescriptions are excluded from coverage: Please check active document for current restrictions.

• Appetite suppressants.
• Prescription refills necessitated by loss or theft.
• Drugs used for cosmetic purposes.
• Unit dose (except for nursing home patients) or convenience packaging when the cost of the medication exceeds the cost of the same medication in conventional packaging.
• Drugs that are investigative or not approved by the Food and Drug Administration.
• Drugs requiring prior authorization review by Medica, until the review determination is completed. Refer to the Medica Drug Formulary for the prior authorization procedure.
• Homeopathic medicine.