general guidelines - resource brokerage€¦ · 5’4 92-186 187-229 230-252 5’5 94-192 193-234...
TRANSCRIPT
General GuidelinesOur goal in underwriting is to issue your LTCi business in a timely manner.
Underwriting long term care insurance requires attention to an applicant’s:
• current functional and cognitive ability
• current medical conditions including medications
An important component of successful long term care sales is thoroughfield underwriting. Please review the following guidelines.
Eligible issue ages 18-84 based on age nearest birthday.*
We consider applicants age nearest 85, but only prior to their 85thbirthday. Some state restrictions may apply.
FOR PRODUCER USE ONLY. NOT FOR USE WITH THE PUBLIC.
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Premium Rate ClassesSignatureCare offers three premium rate classes that you may quote:Ultra Preferred, Select Preferred and Preferred. Underwriting decisionswill depend on the multiplicity and severity of the medical conditionsalong with other factors. The final underwriting determination will bebased on the information that was reviewed for the applicant. It iscritical that you quote the appropriate rate class and in the event yourclient qualifies for a better rate than quoted, we will contact you todetermine whether to issue with a lower rate or increased benefits.MassMutual Financial Group LTCi underwriting has the full authority toissue coverage, modify coverage, or deny coverage based on bothmedical and non medical factors irrespective of the suggestedguidelines that are outlined in the Field Underwriting Guide.
Quoting:It is recommended to check each medical condition reported by theclient in the Field Underwriting Guide and not to quote the ultra-preferred rate if two or more ultra preferred conditions are disclosedsince certain conditions may represent greater risk. Since your clientmay be disappointed with a premium higher than you originally quoted,it is critical that you quote the appropriate rate class.
The following premium rate classes are offered:
• Ultra Preferred (85%)
• Select Preferred (100%)
• Preferred (125%)
FOR PRODUCER USE ONLY. NOT FOR USE WITH THE PUBLIC.
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The following is a list of the classifications defined and some generalguidelines for determining qualification:
ULTRA PREFERRED (ALL MUST APPLY)For very healthy non-smoking applicants.
• Non-cigarette smoker for the last 12 months(other tobacco use acceptable)
• Weight is within Ultra Preferred range on Height/Weight Chart
• Consultation with a physician in the last 24 months
• Applicants with no medical history or considered to be undertreatment for a mild medical impairment
• No current treatment for a serious condition (such as heart orcirculatory disorder, diabetes, rheumatoid arthritis or cancer)
• Applicants may be receiving regular treatment of a preventativenature only, for example:
• Medication such as thyroid replacement, hormonalsupplements, digestive aids, or analgesics and anti-inflammatory medications that are used on an as neededbasis are acceptable.
• High blood pressure that is kept in the normal range (140/90to 120/80) with medication is acceptable, but cannot be incombination with other heart disorders.
SELECT PREFERRED (ONE OR MORE OF THE FOLLOWING APPLY)For individuals that are currently being treated for minimal to moderatemedical impairments or in combination but are considered to be stableand under adequate control.
• Cigarette Smoker with no other significant medical history andotherwise in good health
• Weight is within the Select Preferred range on Height/Weight Chart
• Medical history of cardiac or circulatory disorder, diabetes,rheumatoid arthritis, or cancer with excellent prognosis
FOR PRODUCER USE ONLY. NOT FOR USE WITH THE PUBLIC.
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• Under regular treatment with prescription medications listed inthe Prescription Drug Guide for Conditions Not Eligible for UltraPreferred Rates.
• No medical consultation within the last 24 months
PREFERRED (ONE OR MORE OF THE FOLLOWING APPLY)For applicants with moderate to significant medical impairments due tohealth history, weight problems, smoking status or some combination ofthese factors but whose medical problems are well controlled andwhose overall health status is stable
• Under treatment for moderate to significant chronic healthcondition which requires close medical supervision (such asrheumatoid arthritis, ulcerative colitis, or emphysema)
• History of a combination of moderate to significant medicalimpairments (such as heart and lung disease, or rheumatoidarthritis with coronary artery disease)
• Weight is within the Preferred range on Height/Weight Chart
Additional Rate Classes used for Limited Benefit Offer Only: Thereare two additional rate classes available and will be offered to thoseapplicants who have a combination of medical conditions that pose ahigher, but not immediate risk, of utilization of long term care services.This is done at the underwriter’s discretion and only after allunderwriting requirements have been reviewed. Your underwriterwill call to discuss the offer.
Postpone: The medical condition has a specified stability period andmay be considered at a later date.
Uninsurable: The medical condition is not acceptable.
Previously Declined CasesIn general, individuals who have been previously declined for long termcare coverage are unlikely to qualify for coverage. Should an application besubmitted for an individual who has been declined previously, it is requiredthat a copy of the declination letter that provides the specific reason orreasons for the decline decision be submitted with the application.
FOR PRODUCER USE ONLY. NOT FOR USE WITH THE PUBLIC.
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Height/Weight ChartThe height and weight charts are used for the purpose of assessingwhether a person has an increased risk of morbidity. The followingcharts set forth MassMutual’s guidelines for Males and for Females.Anyone outside the parameters listed on the following tables isconsidered a high risk for use of Long Term Care services and will beconsidered for coverage on an individual basis.
MALE BUILD CHART (WEIGHT IS IN POUNDS)
Height Ultra Preferred Select Preferred Preferred
5’0 92-186 187-214 215-235
5’1 94-190 191-217 218-239
5’2 96-194 195-222 223-244
5’3 99-201 202-227 228-250
5’4 102-206 207-232 233-255
5’5 104-209 210-238 239-262
5’6 107-217 218-244 245-268
5’7 110-222 223-250 251-275
5’8 113-229 230-257 258-283
5’9 116-234 235-264 265-290
5’10 119-240 241-271 272-298
5’11 122-246 247-278 279-306
6’0 125-254 255-288 289-317
6’1 128-259 260-292 293-321
6’2 129-267 268-299 300-329
6’3 135-274 275-307 308-338
6’4 139-282 283-315 316-347
6’5 143-288 289-323 324-355
6’6 147-297 298-331 332-364
6’7 151-306 307-339 340-373
6’8 155-314 315-347 348-382
FOR PRODUCER USE ONLY. NOT FOR USE WITH THE PUBLIC.
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FEMALE BUILD CHART (WEIGHT IS IN POUNDS)
Height Ultra Preferred Select Preferred Preferred
4’8 78-157 158-191 192-210
4’9 79-160 161-195 196-215
4’10 80-163 164-199 200-219
4’11 82-166 167-203 204-223
5’0 84-170 171-208 209-229
5’1 86-174 175-213 214-234
5’2 88-178 179-218 219-240
5’3 90-184 185-223 224-245
5’4 92-186 187-229 230-252
5’5 94-192 193-234 235-257
5’6 97-197 198-239 240-263
5’7 99-201 202-245 246-270
5’8 102-207 208-251 252-276
5’9 105-212 213-257 258-283
5’10 108-218 219-264 265-290
5’11 111-225 226-272 273-299
6’0 115-232 233-282 283-310
6’1 118-240 241-292 293-321
6’2 121-247 248-300 301-330
6’3 124-254 255-309 310-340
6’4 127-260 261-318 319-350
FOR PRODUCER USE ONLY. NOT FOR USE WITH THE PUBLIC.
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Medical Condition GuidelinesAAbscess – A localized collection of pus in any part of the body.
• resolved or 6 months after surgery . . . . . . . . .ULTRA PREFERRED
• brain or abdominal
• present or surgery within 6 months . . . . . . . .POSTPONE
Acoustic Neuroma – A benign tumor that may develop in the hearingand balance nerves in the inner ear.
• surgically removed . . . . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED
• present . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Addison’s Disease – A severe hormonal deficiency of the adrenal gland.
• well controlled on medication . . . . . . . . . . . .SELECT PREFERRED
Adhesions
• post surgery, full recovery . . . . . . . . . . . . . . . .ULTRA PREFERRED
ADL (Activities of Daily Living) Deficits
• any mental or physical limitation in performing theactivities of daily living . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Adult Day Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
AIDS (Acquired Immunodeficiency Syndrome) . . . . .UNINSURABLE
Alcoholism – A disease marked by excessive consumption of anddependence on alcoholic drinks.
• recovered more than 5 years, in good health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED
• recovered more than 3 years, in good health . . . . . . .PREFERRED
• within 3 years or with relapses . . . . . . . . . . . . . . .UNINSURABLE
Allergies and Hay Fever . . . . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED
FOR PRODUCER USE ONLY. NOT FOR USE WITH THE PUBLIC.
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Alzheimer's Disease – The deterioration of intellectual functions.
• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Amaurosis Fugax – A temporary, partial, or complete loss of vision.
• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Amnesia – Memory loss, sometimes including the memory ofpersonal identity
• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Amputation – To cut off or remove usually through surgery a projectingbody part.
• due to trauma or congenital, independent,no ADL limitations . . . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED
• due to disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Amyotrophic Lateral Sclerosis (Lou Gehrig’s Disease) – The degeneration of muscular activity within the brain and thespinal cord.
• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Anemia – A deficiency of red blood cells in the blood.
• mild . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED
• moderate . . . . . . . . . . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED
• severe or with complications or defined as Aplastic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Aneurysm – Abnormal expansion of a blood vessel.
• abdominal or thoracic, 1 year after surgerywith good recovery . . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED
• cerebral, with or without surgery . . . . . . . . . . . . . .UNINSURABLE
• present or surgery within 1 year . . . . . . . . . . . . . . . . . .POSTPONE
FOR PRODUCER USE ONLY. NOT FOR USE WITH THE PUBLIC.
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Angina Pectoris – Severe pain and constriction in region of the heart.
• controlled on medications . . . . . . . . . . . . . . . .SELECT PREFERRED
• occasional episodes, or with historyof myocardial infarction . . . . . . . . . . . . . . . . .SELECT PREFERRED
• with current (or within past 12 months)cigarette smoking . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Angioplasty, Cardiac – Repair of a blood vessel with a balloon orthrough a surgical procedure.
• after 6 months, with or without medication . .SELECT PREFERRED
• with stent, after 6 months, with orwithout medication . . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED
• with history of myocardial infarction . . . . . . .SELECT PREFERRED
• with current cigarette smoking, ongoing heart failure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Ankylosing Spondylitis – Chronic inflammation of the spine andsacroiliac joints.
• mild . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED
• moderate . . . . . . . . . . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED
• with narcotic use or physical limitations . . . . . . . .UNINSURABLE
Anxiety Disorder – A state of apprehension, uneasiness, and fear.
• situational with occasional medication . . . . . .ULTRA PREFERRED
• moderate with regular ormultiple medications . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED
• with hospitalization past 5 yearsor with functional impairment . . . . . . . . . . . . . . . .UNINSURABLE
Aplastic Anemia
• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
FOR PRODUCER USE ONLY. NOT FOR USE WITH THE PUBLIC.
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Arnold-Chiari Malformation – A genetic disorder occurring in thelower portion of the brain in the cerebellum or brainstem. Ultimatelyaffects balance, fine motor coordination, and unsteadiness in gait.
• Type 1 only, surgically repaired,after 5 years, no residuals . . . . . . . . . . . . . . .SELECT PREFERRED
• present . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Arrhythmias (other than Atrial Fibrillation) – Irregular heartbeat.
• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED
Arteriovenous Malformations (AVM) – An abnormal collection ofblood vessels.
• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Arteritis – Inflammation of an artery.
• currently being treated . . . . . . . . . . . . . . . . . . . . . . . . .POSTPONE
• off therapy more than 1 year, in remission . .SELECT PREFERRED
Arthritis (Degenerative or Osteoarthritis) – The breakdown anddeterioration of cartilage in the joints.
• mild, asymptomatic, no treatment oroccasional medication . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED
• moderate, with routine NSAID orjoint injections . . . . . . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED
• significant, taking multiple medications,no physical limitations . . . . . . . . . . . . . . . . . . . . . . . . .PREFERRED
• with physical limitations, multiple jointreplacements or surgery anticipated . . . . . . . . . . .UNINSURABLE
FOR PRODUCER USE ONLY. NOT FOR USE WITH THE PUBLIC.
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Arthritis (Rheumatoid) – A chronic systemic disease marked byinflammatory changes in the joints.
• mild, controlled with non-steroidal medications,no deformities . . . . . . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED
• moderate to severe, requiringmultiple medications . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
• with physical limitations or surgery anticipated . .UNINSURABLE
Arthroscopy – Examination of or joint surgery using an arthroscope.
• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED
Asbestosis – A respiratory disease caused by inhaling asbestos fibersthat can lead to breathing problems and heart failure.
• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Assisted Living . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Asthma – A disease of the respiratory system characterized by difficultyof breathing.
• mild, seasonal, infrequent attacks withshort term medication use . . . . . . . . . . . . . . . .ULTRA PREFERRED
• moderate, controlled with medications(no steroids) . . . . . . . . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED
• severe, requiring multiple medications or steroids . . .PREFERRED
• with current (or within past 12 months)cigarette smoking . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Atrial Fibrillation – A severe, chaotic irregular heartbeat, which couldlead to heart failure or strokes.
• new onset, < 6 months . . . . . . . . . . . . . . . . . . . . . . . . .POSTPONE
• history of, successful cardioversion,normal sinus rhythm . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED
• currently on anticoagulation medication . . . . . . . . . . .PREFERRED
• described as chronic, intermittent,or with multiple cardioversions . . . . . . . . . . . . . . .UNINSURABLE
FOR PRODUCER USE ONLY. NOT FOR USE WITH THE PUBLIC.
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Attention Deficit Disorder (ADD) and Attention DeficitHyperactivity Disorder (ADHD) – A persistent pattern of inattentionand hyperactivity-impulsivity that occurs more frequently or severelythan is typical.
• stable, well controlled on single medication . .ULTRA PREFERRED
• stable on more than 1 medication . . . . . . . . .SELECT PREFERRED
Autoimmune Disorders – A person’s immune system begins to attackits own body, creating antibodies against its own tissue.
• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Avascular Necrosis – A disease resulting from loss of blood supply tothe bones causing death of bone tissue and bone collapse.
• mild, surgically corrected, . . . . . . . . . . . . . . . SELECT PREFERRED
BBack Pain
• mild, intermittent medication, nounderlying disease process . . . . . . . . . . . . . . .ULTRA PREFERRED
• due to herniated disc (unoperated) orspinal disorder . . . . . . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED
• surgery anticipated . . . . . . . . . . . . . . . . . . . . . . . . . . . .POSTPONE
Barrett’s Esophagus – A condition of the esophagus in which thenormal tissue changes into abnormal tissue caused by recurrent refluxof gastric juices.
• biopsy done within the last 2 yearswith favorable results . . . . . . . . . . . . . . . . . . .SELECT PREFERRED
Basal Cell Skin Cancer
• completely excised . . . . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED
Bell’s Palsy – Temporary paralysis of the facial muscles
• history of, complete recovery . . . . . . . . . . . . . .ULTRA PREFERRED
FOR PRODUCER USE ONLY. NOT FOR USE WITH THE PUBLIC.
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Benign Prostatic Hypertrophy (BPH) – An enlargement of theprostate.
• PSA’s normal, controlled with medication,no surgery anticipated . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED
• with surgery and full recovery . . . . . . . . . . . . .ULTRA PREFERRED
Biliary Cirrhosis – A liver disease that slowly destroys the bile ducts inthe liver.
• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Bi-Polar Disorder – A mood disorder characterized by mood swingsfrom mania (exaggerated feeling of well-being) to depression
• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Bladder Infection – Urinary
• history of infection, complete recovery . . . . . .ULTRA PREFERRED
• chronic infections, without incontinence . . . .SELECT PREFERRED
Bladder Prolapse (Cystocele) – The dropping or sagging of a women’sbladder due to the weakness of the bladder.
• surgically repaired . . . . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED
Blood Pressure, Elevated – A higher than normal blood pressure.(check list for cardiac medications)
• mild and no other cardiac condition . . . . . . . . .ULTRA PREFERRED
• in combination with othercardiac condition . . . . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED
• poor medication compliance or not controlled . . . .UNINSURABLE
Brain Tumor – Abnormal growth in or on the brain
• after 5 years following removal,benign, no residuals . . . . . . . . . . . . . . . . . . . . . . . . . . .PREFERRED
• all others . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Breast Disorders – Any type of lump, swelling, cyst or mass that canbe felt in the breast tissue.
• fibrocystic disease . . . . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED
FOR PRODUCER USE ONLY. NOT FOR USE WITH THE PUBLIC.
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Bronchiectasis – A chronic expansion and destruction of the bronchiof the lungs, with secondary infection.
• asymptomatic, non-cigarette smoker, minimum 1 year sincediagnosis, normal pulmonary function tests . . . . . . . .PREFERRED
• chronic, with hospitalizations . . . . . . . . . . . . . . . . .UNINSURABLE
Bronchitis – Acute or chronic inflammation of the bronchial tube.
• acute attack, nonsmoker . . . . . . . . . . . . . . . . . .ULTRA PREFERRED
• multiple attacks, smoker . . . . . . . . . . . . . . . . .SELECT PREFERRED
• chronic, nonsmoker . . . . . . . . . . . . . . . . . . . . . . . . . . . .PREFERRED
• chronic, with current (or within past 12 months)cigarette smoking . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Buerger’s Disease (Thromboangiitis Obliterans) – A chronic,recurring, inflammatory, vascular disease of the peripheral arteriesand veins.
• current . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
• full recovery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .PREFERRED
• chronic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Bypass Surgery (Heart) – A surgery that reroutes the blood supply bybypassing blocked arteries.
• after 6 months, with good results . . . . . . . . .SELECT PREFERRED
• with history of myocardial infarction . . . . . . .SELECT PREFERRED
• with current (or within past 12 months)cigarette smoking . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
CCancer – An uncontrolled growth of abnormal cells which havemutated from normal tissue.
Bladder
Early Stage 0 (in situ), 2 year fromlast treatment . . . . . . . . . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED
FOR PRODUCER USE ONLY. NOT FOR USE WITH THE PUBLIC.
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Early Stages (A, B1, B2), 2 years fromlast treatment . . . . . . . . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED
Early stages (A, B1, B2), 5 years fromlast treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED
All other stages, over 2 years fromlast treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .PREFERRED
Any invasion of regional lymphatics, metastasis,or recurrence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Breast
Early Stage 0, 1, 2, over 2 years fromlast treatment . . . . . . . . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED
Early Stage 0,1,2, over 5 years fromlast treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED
Stages III, IV over 2 years from last treatment . . . . . . . .PREFERRED
Stages III, IV, over 5 years from last treatment .SELECT PREFERRED
Any invasion of regional lymphatics, metastasis,or recurrence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Colon
Stages 0, I (Dukes A) 2 years fromlast treatment . . . . . . . . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED
Stages 0, I (Dukes A) 5 years fromlast treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED
Stages IIA, IIB (Dukes B), IIIA (Dukes C) 2 yearsfrom last treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . .PREFERRED
Stages IIA, IIB (Dukes B), IIIA (Dukes C) 5 yearsfrom last treatment . . . . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED
Any invasion of regional lymphatics, metastasis,or recurrence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
FOR PRODUCER USE ONLY. NOT FOR USE WITH THE PUBLIC.
15
Esophagus
Stage 0 (in situ), 5 years from last treatment . . . . . . . . .PREFERRED
Any invasion of regional lymphatics,metastasis, or recurrence . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Kidney
Stage I, II, 2 years from last treatment . . . . . . .SELECT PREFERRED
Stage I, II, 5 years from last treatment . . . . . . . .ULTRA PREFERRED
All other stages, over 2 years from last treatment . . . . .PREFERRED
Any invasion of regional lymphatics,metastasis, or recurrence . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Liver
All stages within 5 years . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
All stages 5 years from last treatment . . . . . . . . . . . . . .PREFERRED
Lung
All stages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Lymphoma
Stages I, II, 10 years from last treatment . . . . . . . . . . . .PREFERRED
Melanoma
Stage 0 (in situ), 1 year from last treatment . . . .ULTRA PREFERRED
Stages IA, IB, IIA, IIB, 2 years fromlast treatment . . . . . . . . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED
Stages IA, IB, IIA, IIB, 5 years fromlast treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED
Stage IIIA, 2 years from last treatment . . . . . . . . . . . . . .PREFERRED
Stage IIIA, 5 years from last treatment . . . . . . .SELECT PREFERRED
Any invasion of regional lymphatics,metastasis, or recurrence . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
FOR PRODUCER USE ONLY. NOT FOR USE WITH THE PUBLIC.
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Ovarian
Stages IA, IB, IC, 2 years from last treatment . .SELECT PREFERRED
Stages IA, IB, IC, 5 years from last treatment . . .ULTRA PREFERRED
Stage IIA, 2 years from last treatment . . . . . . . . . . . . . .PREFERRED
Stage IIA, 5 years from last treatment . . . . . . . .SELECT PREFERRED
Any invasion of regional lymphatics,metastasis, or recurrence . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Prostate
Grade 1, 2 years from last treatment . . . . . . . . .SELECT PREFERRED
Grade 1, 5 years from last treatment . . . . . . . . . .ULTRA PREFERRED
Grade 2-3, 2 years from last treatment . . . . . . . . . . . . . .PREFERRED
Grade 2-3, 5 years from last treatment . . . . . . ..SELECT PREFERRED
Any invasion of regional lymphatics, metastasis,
Or recurrence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Cane Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Cardiomyopathy – A disease that damages the heart muscle so that itloses its ability to pump blood and can cause irregular heartbeats.
• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Carotid Artery Disease – A constriction or narrowing of the arteriesthat supply the blood flow to the neck and brain.
• nonsmoker, asymptomatic or corrected by endarterectomy, nohistory of TIA or stroke . . . . . . . . . . . . . . . . . .SELECT PREFERRED
• nonsmoker, asymptomatic, with otherheart or circulatory disorder . . . . . . . . . . . . . . . . . . . . .PREFERRED
• severe; symptomatic or cigarette smoker . . . . . . .UNINSURABLE
FOR PRODUCER USE ONLY. NOT FOR USE WITH THE PUBLIC.
17
Carpal Tunnel Syndrome – A painful and progressive condition causedby compression of the median nerve.
• successful surgery, no residuals . . . . . . . . . . . .ULTRA PREFERRED
• surgery anticipated, with functional limits . . . . . . . . . .POSTPONE
Cataracts – A clouding of the lens or the eye, which obstructs thepassage of light.
• recovered after surgery . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED
• present but not requiring surgery,no visual impairment . . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED
• surgery scheduled or anticipated . . . . . . . . . . . . . . . . .POSTPONE
Catheter (current use; indwelling) A tubular medical device forinsertion into canals, vessels, or passageways to permit injection orwithdrawal of fluids.
• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Cerebral Palsy – A disorder of movement and gait caused by braindamage.
• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Cerebral Vascular Accident (CVA) – The blood supply to a part of thebrain is interrupted by an ischemic stroke or by a hemorrhagic stroke.
• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Charcot-Marie-Tooth Disease – A hereditary progressiveneuromuscular disorder that primarily affects the feet, leg, and hands.
• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Cholecystitis, Cholelithiasis (see Gallbladder) – A suddeninflammation of the gallbladder that causes severe pain.
Chronic Fatigue Syndrome – A prolonged persistent fatigue that canbe incapacitating and/or debilitating.
• mild, controlled with medication, not affectingfunctional ability . . . . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED
• with depression . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .PREFERRED
FOR PRODUCER USE ONLY. NOT FOR USE WITH THE PUBLIC.
18
• severe, with functional limitations;use of steroids or narcotics . . . . . . . . . . . . . . . . . .UNINSURABLE
Chronic Obstructive Pulmonary Disease (COPD) – A severe diseaseof the lungs that obstructs the airways.
• nonsmoker, controlled with 1-2 medications/inhalers, nohospitalizations . . . . . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED
• nonsmoker, controlled with 1-2 medications, occasional steroiduse, no hospitalizations . . . . . . . . . . . . . . . . . . . . . . . .PREFERRED
• with current (or within past 12 months) cigarette smoking,oxygen use, hospitalizations, daily steroid use, with heartor circulatory disorders . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Cirrhosis, Liver – The gradual loss of liver function due to cell damageand internal scarring.
• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Cognitive Impairment – The inability to mentally function normally,reduction in memory, thinking, and learning.
• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Colitis – A chronic, episodic, inflammatory disease of the large intestineand rectum characterized by bloody diarrhea.
• controlled with medication . . . . . . . . . . . . . . .SELECT PREFERRED
• occasional flares, treated with steroids,normal weight . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .PREFERRED
• recurrent flares, hospitalizations, weight loss,chronic steroids . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Collagen Vascular Disease – Any disorder affecting the connectivetissue, with rheumatic symptoms including muscle stiffness, soreness,and pain in the joints.
• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Colostomy – An opening of a portion of the colon through theabdominal wall.
• 2 years after surgery, no complications . . . . .SELECT PREFERRED
FOR PRODUCER USE ONLY. NOT FOR USE WITH THE PUBLIC.
19
Confusion
• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Congestive Heart Failure (CHF) – The heart’s inability to maintainsufficient cardiac output to meet the body’s needs.
• controlled with medications for 1 year, singleevent, ejection fraction >45% . . . . . . . . . . . . . . . . . . .PREFERRED
• chronic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Connective Tissue Disease (see Collagen Vascular Disease)
Coronary Artery Disease – A condition that reduces the blood flowthrough the coronary arteries to the heart muscle.
• with angina or positive cardiac test . . . . . . . .SELECT PREFERRED
• with history of myocardialinfarction or angioplasty . . . . . . . . . . . . . . . . .SELECT PREFERRED
• with current (or within past 12 months)cigarette smoking, or multiple heart attacks . . . . .UNINSURABLE
CREST Syndrome (see Scleroderma)
Crohn’s Disease – Inflammation and ulceration of the small intestine.
• controlled with medication . . . . . . . . . . . . . . .SELECT PREFERRED
• occasional flares, treated with steroids,normal weight . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .PREFERRED
• recurrent flares, hospitalizations, weight loss,chronic steroids . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Cushing’s Syndrome (due to Pituitary, Adrenal or Ectopic Tumors)– A hormonal disorder resulting from the overproduction ofcorticosteroid by the adrenal gland.
• corrected by surgery, no complications or secondarydisorders such as high blood pressure, osteoporosisor diabetes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .PREFERRED
• present . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
FOR PRODUCER USE ONLY. NOT FOR USE WITH THE PUBLIC.
20
CVA (see Stroke)
Cystic Fibrosis – An inherited disease characterized by chronic lunginfections and an inability to absorb fats or other nutrients from foods.
• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Cystitis – Inflammation of the urinary bladder.
• acute . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED
DDegenerative Joint Disease (see Arthritis)
Dementia – A cognitive deficit including memory impairment.
• all forms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Demyelinating Disease – Causing or characterized by the loss ordestruction of myelin (the sheath around nerve fibers), such asmultiple sclerosis.
• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Depression – A mental disorder marked by sadness, inactivity, difficultywith thinking and concentration, feelings of helplessness andworthlessness.
• mild, situational or treated with occasional, regular, or multiplemedication . . . . . . . . . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED
• chronic with multiple medications, hospitalizationsUNINSURABLE
Dermatomyositis – An autoimmune disorder in which the muscles andskin become inflamed, causing weakness of the muscles and a skin rash.
• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Diabetes Mellitus, Insulin Dependent – A chronic disease ofcarbohydrate metabolism in which the body makes little or no insulin,requiring daily injections of insulin to sustain life.
• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Diabetes Mellitus, Non-Insulin Dependent (diet or oralmedications) – A chronic disease of carbohydrate metabolism, markedby high blood sugar and sugar in urine, resulting from inadequate
FOR PRODUCER USE ONLY. NOT FOR USE WITH THE PUBLIC.
21
production or use of insulin.
• newly diagnosed or change in medications < 1 year . .POSTPONE
• diet or oral medication control . . . . . . . . . . . .SELECT PREFERRED
• diet or medication control, overweight, . . . . . . . . . . . .PREFERRED
• poor control or with other serious health conditions, diabeticcomplications, cigarette smoker or smoker within past12 months . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Dialysis, Kidney – A procedure to remove the waste products from theblood and excess fluid from the body as a treatment for kidney failure.
• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Diverticulitis, Diverticulosis (see Irritable Bowel Syndrome) –Diverticulitis is inflammation and perforation of a diverticulum (anabnormal pouch or sac of the intestine), Diverticulosis is a conditionwhere small sacs of the inner lining of the intestine are present.
Down’s Syndrome – A chromosome abnormality resulting in moderateto severe mental retardation and other abnormalities
• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Drug Dependency or Abuse
• after 5 years, complete abstinenceincluding alcohol . . . . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED
• after 3 years, complete abstinenceincluding alcohol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .PREFERRED
• within 3 years or with relapses . . . . . . . . . . . . . . .UNINSURABLE
Duodenal Ulcer – A peptic ulcer situated in the small intestines.
• history of, occasional medication . . . . . . . . . . .ULTRA PREFERRED
• chronic, frequent flare ups and/or bleeding . .SELECT PREFERRED
• surgery anticipated or scheduled . . . . . . . . . . . . . . . . .POSTPONE
Dupuytren’s Contracture – A painless thickening and contracture oftissue beneath the skin on the palm of the hand.
• present or surgically corrected, no functional
FOR PRODUCER USE ONLY. NOT FOR USE WITH THE PUBLIC.
22
limitations or other disease present . . . . . . . .ULTRA PREFERRED
• surgery anticipated or scheduled . . . . . . . . . . . . . . . . .POSTPONE
EEmphysema (see Chronic Obstructive Pulmonary Disease)
Endarterectomy (see Carotid Artery Disease) – surgery to remove orbypass fatty deposits or blockage in an artery.
Endocarditis – Inflammation of the inner lining of the heart.
• fully recovered > 6 months, 1 episode,no residuals . . . . . . . . . . . . . . . . . . . . . . . . . . . .SELECT REFERRED
• recurrent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Epilepsy (Seizures) – Transient neurological abnormalities caused byabnormal electric activity in the brain.
• controlled on medication,seizure free > 12 months . . . . . . . . . . . . . . . . .SELECT PREFERRED
• seizure within 1 year; poorcontrol or cause unknown . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Epstein-Barr Syndrome – A herpes virus that causes infectiousmononucleosis.
• 6 months after full recovery, no residuals . . . .ULTRA PREFERRED
• current evaluation or work up . . . . . . . . . . . . . . . . . . . .POSTPONE
Esophageal Varices – Twisted, expanded areas in the esophagealveins resulting from portal hypertension caused by advanced liverdisease.
• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Esophagitis – Inflammation of the esophagus.
• mild, well controlled by diet or medication . . .ULTRA PREFERRED
• recurrent or with bleeding . . . . . . . . . . . . . . .SELECT PREFERRED
FOR PRODUCER USE ONLY. NOT FOR USE WITH THE PUBLIC.
23
FFalls
• multiple (3) with or without injury in past 5 years .UNINSURABLE
Fatty Liver – Accumulation of excess fat in the liver cells. Some causesare obesity, high triglycerides and alcohol use.
• liver function tests normal, stable . . . . . . . . .SELECT PREFERRED
• abnormal liver function tests or relatedto alcohol intake . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Fibrocystic Breast Disease – A benign breast lump characterized bycysts and thickening of the milk glands.
• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED
Fibromyalgia – A chronic disorder of the muscles and related softtissue including ligaments and tendons, characterized by muscle pain,fatigue, and sleep disturbances.
• mild, controlled with minimal medication,no limitations . . . . . . . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED
• with chronic fatigue, weakness, functional limitations;use of steroids or narcotics . . . . . . . . . . . . . . . . . .UNINSURABLE
Fractures
• arm, due to trauma, no functional impairment,full recovery . . . . . . . . . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED
• leg, due to trauma, no functional impairment,full recovery . . . . . . . . . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED
• pelvis, due to trauma,no functional impairment . . . . . . . . . . . . . . . .SELECT PREFERRED
• Vertebral, due to trauma,no functional limits . . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED
• Vertebral, due to osteoporosis . . . . . . . . . . . . . . . .UNINSURABLE
• Paget’s disease . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
FOR PRODUCER USE ONLY. NOT FOR USE WITH THE PUBLIC.
24
Fuch’s Corneal Dystrophy – A gradual deterioration of one layer oranother of the cornea, which causes clouding and blurred vision.
• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
GGallbladder (Cholecystitis, Cholelithiasis) – A sudden inflammationof the gallbladder that causes severe pain.
• medically managed . . . . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED
• after 3 months surgery . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED
• pending or anticipated surgery . . . . . . . . . . . . . . . . . . .POSTPONE
Gastric Bypass Surgery (Stapling, Banding) – Surgery to promoteweight loss by reducing the size of the stomach and/or interrupting thedigestive process.
• after 6 months, must use weight attime of surgery . . . . . . . . . . . . . . . . . . . . . . . . . .SEE BUILD CHART
• after 24 months, use current weight . . . . . . . . . . . . . . . . . .CHART
Gastroesophageal Reflux Disease (GERD) – Regurgitation of gastricjuices into the lower esophagus.
• well controlled by diet or medication . . . . . . .ULTRA PREFERRED
• recurrent symptoms or flare ups . . . . . . . . . . .SELECT PREFERRED
Gilbert’s Disease (confirmed diagnosis) – An inherited disorder thataffects the way bilirubin is processed by the liver.
• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED
Glaucoma – A group of eye diseases that cause damage to the opticnerve which lead to blindness.
• treated with eyes drops,no visual impairment . . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED
• with progressive visual loss . . . . . . . . . . . . . . . . . .UNINSURABLE
Goiter – An enlargement of the thyroid gland.
• post surgery or post radioactive iodine treatment, benign,on thyroid replacement . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED
FOR PRODUCER USE ONLY. NOT FOR USE WITH THE PUBLIC.
25
Gout – Recurrent inflammation of the peripheral joints, which maybecome chronic and cause joint deformity.
• controlled with medication, no flare up . . . . . .ULTRA PREFERRED
• with recurrent flare ups, . . . . . . . . . . . . . . . . .SELECT PREFERRED
Graves’ Disease – An autoimmune disease that causes over activity ofthe thyroid gland.
• controlled by medication . . . . . . . . . . . . . . . . .ULTRA PREFERRED
Guillian-Barre Syndrome – A disorder in which the body’s immunesystem attacks the peripheral nerves, which are outside the brain andspinal cord.
• full recovery after 12 months, no residuals or functionallimitations . . . . . . . . . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED
• full recovery with minimal residuals after 12 months, nofunctional limitations . . . . . . . . . . . . . . . . . . . . . . . . . .PREFERRED
HHashimoto’s Thyroiditis – An inflammation of the thyroid gland, thatfrequently results in hypothyroidism (low thyroid).
• controlled by thyroid replacement therapy . . .ULTRA PREFERRED
Headaches – Diffuse pain in different portions of the head, notconfined to any nerve distribution area.
• occasional medication . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED
Heart Attack – Insufficient blood supply to the heart muscle.
• after 6 months, single attack, 1-2 medications, stable and fullyfunctional . . . . . . . . . . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED
• after 12 months, second or multiple attacks, 1-2 medications,stable, fully functional . . . . . . . . . . . . . . . . . . . . . . . . .PREFERRED
• with chronic angina (chest pain) . . . . . . . . . . . . . . . . .PREFERRED
• current cigarette smoker or smokerwithin past 12 months . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
FOR PRODUCER USE ONLY. NOT FOR USE WITH THE PUBLIC.
26
Heart Blocks – A condition in which the signal from the heart’s upperto lower chambers is impaired or doesn’t transmit.
• left bundle branch block with normalstress test, echo . . . . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED
• right bundle branch block with normalstress test, echo . . . . . . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED
• First-degree AV Block, asymptomatic, treatment free,no underlying cardiac conditions . . . . . . . . . . .ULTRA PREFERRED
• Second-degree AV Block, asymptomatic, no underlyingcardiac conditions . . . . . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED
• Third-degree AV Block, asymptomatic, medicallytreated or with successful pacemaker implant, withknown heart disease, after 12 months . . . . . . . . . . . .PREFERRED
Heart Valve Disease with Replacement – A surgery used to repair orreplace diseased heart valves.
• after 6 months . . . . . . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED
• surgery scheduled or anticipated . . . . . . . . . . . . . . . . .POSTPONE
Hemochromatosis/Hemosiderosis – A disorder that causes the bodyto absorb excess iron, which accumulates in the liver, pancreas, heart,and in other organs.
• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Hemophilia – An inherited disorder in which a person’s blood lacks acertain protein important in forming blood clots, leading to excessivebleeding.
• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Hemorrhoids – A mass of dilated veins in swollen tissue at the marginof the anus or nearby within the rectum. Also known as piles.
• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED
FOR PRODUCER USE ONLY. NOT FOR USE WITH THE PUBLIC.
27
Hepatitis (A & B) – An inflammation of the liver caused by viruses,bacteria, parasites, and toxic reactions to drugs, alcohol, and chemicals.
• hepatitis A, full recovery (3 months), normal liverfunction tests . . . . . . . . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED
• hepatitis B, full recovery (12 months), normal liverfunction tests . . . . . . . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED
• described as active, chronic active, ordue to alcohol . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Hepatitis C - The most serious hepatitis virus and the leading cause of chronic hepatitis, end stage liver disease, liver cancer and livertransplants in the US. The C virus is transmitted primarily by blood orblood products. Typically due to IV transfusion, past organ transplant,illegal drug use, or occupationally (health care workers who have hadaccidental needle sticks with infected blood).
• acute infection, after 1 year, considered recovered(virus cleared), no virus detectable, no illegaldrug use history, normal liver biopsy andnormal liver function tests . . . . . . . . . . . . . . .SELECT PREFERRED
• all others . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Herniated Disc – A rupture of an intervertebral disc of the spine with aprotrusion of the disc’s core into the spinal canal.
• post surgery with good recovery . . . . . . . . . . .ULTRA PREFERRED
• present, no surgery planned . . . . . . . . . . . . . .SELECT PREFERRED
• surgery anticipated or scheduled . . . . . . . . . . . . . . . . .POSTPONE
Hiatal Hernia – A portion of the stomach protrudes upward into thechest through an opening in the diaphragm.
• with or without surgery, controlled bydiet or medication . . . . . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED
Hip Replacement (see Joint Replacement)
FOR PRODUCER USE ONLY. NOT FOR USE WITH THE PUBLIC.
28
HIV Positive
• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Hodgkin’s Lymphoma – A malignant growth of cells in thelymph system
• after 10 years, complete remission . . . . . . . . . . . . . . .PREFERRED
Home Care Service
• within the last 12 months . . . . . . . . . . . . . . . . . . . . . . .POSTPONE
Huntington’s Chorea – A genetic disease that involves thedegeneration of the basal ganglia of the brain.
• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Hydrocephalus – A disorder characterized by an excessive amount ofcerebrospinal fluid under pressure within the skull.
• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Hypercholesterolemia (high cholesterol) . . . . . .ULTRA PREFERRED
Hyperglycemia – a condition in which an excessive amount of sugarcirculates in the blood.
• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED
Hyperparathyroidism – The over activity of the parathyroid glandsthat leads to an abnormally elevated level of calcium in the blood.
• surgically corrected, normal calcium,no limitations . . . . . . . . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED
• minimally elevated calcium levels, stable, closely monitored, norelated disorders such as high blood pressure, impaired renalfunction, or bone demineralization . . . . . . . . .SELECT PREFERRED
Hypertension (see Blood Pressure, elevated)
Hyperthyroidism – The over activity of the thyroid gland which resultsin the over production of thyroid hormone.
• controlled with medication . . . . . . . . . . . . . . . .ULTRA PREFERRED
Hypothyroidism – The under activity of the thyroid gland which resultsin the under production of thyroid hormone.
FOR PRODUCER USE ONLY. NOT FOR USE WITH THE PUBLIC.
29
• controlled with medication . . . . . . . . . . . . . . . .ULTRA PREFERRED
Hysterectomy – the surgical removal of the uterus.
• after 3 months, no complicationsor malignancy . . . . . . . . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED
IIleostomy (see Colostomy) – The creation of a surgical passagethrough the abdominal wall into the ileum.
Incontinence, Bowel – The inability of the body to control theevacuative functions.
• surgically corrected . . . . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED
• all others . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Incontinence, Urinary – The inability of the body to control theevacuative functions.
• stress or urge, treated with 1 medication . . . .ULTRA PREFERRED
• treated with surgery, full recovery . . . . . . . . . .ULTRA PREFERRED
• complete loss of control . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Intestinal Obstruction – A partial or complete blockage of the bowelthat results in the failure of the intestinal contents to pass through.
• surgically corrected after 12 months,no residuals . . . . . . . . . . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED
• surgery anticipated or scheduled . . . . . . . . . . . . . . . . .POSTPONE
Irritable Bowel Syndrome – A form of colitis, which is characterizedby constipation and diarrhea.
• controlled with medication,no surgery anticipated . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED
• frequent flare ups and/or bleeding . . . . . . . . .SELECT PREFERRED
ITP (Idiopathic Thrombocytopenic Purpura) – A bleeding disorderthat is caused by too few platelets in the blood.
• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
FOR PRODUCER USE ONLY. NOT FOR USE WITH THE PUBLIC.
30
JJoint Replacement (Knee or Hip) – The replacement of a joint.
• one or both joints, after 6 months,no functional limitations, . . . . . . . . . . . . . . . .SELECT PREFERRED
• surgery anticipated or scheduled . . . . . . . . . . . . . . . . .POSTPONE
KKidney Dialysis (see Dialysis) – The build up of waste and toxins,which are not filtered out of the blood and start to accumulate inthe tissues.
Kidney Failure – Failure of the kidney to perform its essential functions.
• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Kidney Infection – An infection of the kidney and the ducts that carryurine away from the kidney.
• no current treatment, fully recovered . . . . . . . .ULTRA PREFERRED
• currently under treatment,medically managed . . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED
Kidney Stones (Nephrolithiasis) – renal calculi or nephrolithisis.Solid lump made up of crystals that separate from the urine.
• no current treatment, resolved . . . . . . . . . . . . .ULTRA PREFERRED
Kidney Transplant – A surgical procedure to implant a healthy kidneyinto a patient with kidney failure.
• 5 years after transplant, normal renal function tests,no complications . . . . . . . . . . . . . . . . . . . .PREFERRED (No HCBS)
Knee Replacement (see Joint Replacement) – The replacement ofa knee
FOR PRODUCER USE ONLY. NOT FOR USE WITH THE PUBLIC.
31
LLabyrinthitis – An inflammation of the fluid filled chambers in the innerear that sense balance, resulting in vertigo.
• well controlled with occasional medication . .ULTRA PREFERRED
• well controlled on 1-2 medications . . . . . . . .SELECT PREFERRED
Lacunar Infarct (see Stroke) – An area of tissue in the brain thatundergoes death of cells following the cessation of blood supply,resulting from occlusion or stenosis of the supplying artery.
Lambert-Eaton Syndrome (Myasthenia Syndrome) – A conditionmarked by neuropathy and weakness of the limbs.
• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Left bundle branch block (see Heart Blocks) – A defect in thehearts electrical conduction system.
Leukemia (any type) – A group of bone marrow cancers in whichwhite blood cells divide uncontrollably, affecting the production ofnormal white blood cells, red blood cells and platelets.
• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Liver Cyst
• 1-2 cysts, no liver disease . . . . . . . . . . . . . . . .ULTRA PREFERRED
• multiple cysts, no kidney or liver disease . . . .SELECT PREFERRED
Lou Gehrig’s Disease (see Amyotrophic Lateral Sclerosis) – Thedegeneration of muscular activity within the brain and the spinal cord.
Lung Cancer (see Cancer)
Lupus (Discoid) – A chronic disease of the skin characterized byremissions and exacerbation of a scaling, red, macular rash.
• stable after 12 months, negative ANA . . . . . .ULTRA PREFERRED
Lupus Erythematosus (Systemic) – A chronic, inflammatory autoimmune disorder that may affect organ systems including the skin,joints, and internal organs.
• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
FOR PRODUCER USE ONLY. NOT FOR USE WITH THE PUBLIC.
32
Lyme’s Disease – A bacterium that is transmitted by a tick andcharacterized by skin changes, flu like symptoms and joint inflammation.
• correct diagnosis, adequate treatment,no residual, after 3 months . . . . . . . . . . . . . . .ULTRA PREFERRED
• correct diagnosis, adequate treatment,with residuals but full recovery . . . . . . . . . . .SELECT PREFERRED
• questionable diagnosis or current treatment . . . . . . . .POSTPONE
Lymphoma (see Cancer) – A form of cancer a malignant tumor of thelymphoid tissue.
MMacular Degeneration – A deterioration of the central portion of theretina, affecting central vision and visualization of fine details.
• no functional limits, successful adaptationto any visual loss . . . . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED
• progressive visual loss, changes to lifestyleto accommodate vision loss . . . . . . . . . . . . . . . . . .UNINSURABLE
Major Depression – An emotional state characterized by feelings ofpersistent sadness, worthlessness, rejection, loss of hope, and loss ofinterest in usual activities.
• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Manic Depression (see Bipolar)
Marfan’s Syndrome – An inheritable disorder of connective tissue thataffects the skeletal system, cardiovascular system, eyes, and skin.
• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Medicaid Recipient
• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Melanoma (see Cancer) – A malignant skin tumor containingdark pigment.
FOR PRODUCER USE ONLY. NOT FOR USE WITH THE PUBLIC.
33
Memory Loss/Problems – A loss of the ability to memorizeinformation or recall information stored in the brain.
• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Meniere’s Disease – An inner ear disorder, usually accompanied byvarying degrees of hearing loss, ringing in the ears, and dizziness.
• adequately diagnosed by MRI, controlled with occasionalmedication, after 6 months . . . . . . . . . . . . . . .ULTRA PREFERRED
• diagnosis made by symptoms only, not diagnosed by MRI, regularmedication, after 6 months . . . . . . . . . . . . . . .SELECT PREFERRED
• uncontrolled with ongoing symptoms . . . . . . . . . .UNINSURABLE
Menopausal Symptoms (Pre/Post)
• adequately diagnosed, controlled with 1 depression medication inlieu of hormone replacement therapy . . . . . . .ULTRA PREFERRED
Mental Retardation – A condition characterized by impairedintellectual function which interferes with the ability to cope in everydayactivities.
• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Migraine Headaches – A severe, sometimes incapacitating headache,which can be accompanied by visual changes or stomach disturbances.
• uncomplicated, controlled withoccasional medication . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED
• described as complicated,uncontrolled orwith chronic pain and limitations . . . . . . . . . . . . . .UNINSURABLE
Mitral Valve Prolapse – A condition, in which the mitral valve in theheart is deformed, causing a degree of leakage and is characterized by aheart murmur and sometimes chest pain.
• no symptoms, normal EKG, may or may nottake antibiotic for prophylactic reasons . . . . . .ULTRA PREFERRED
• symptomatic or with other heart condition . .SELECT PREFERRED
FOR PRODUCER USE ONLY. NOT FOR USE WITH THE PUBLIC.
34
Monoclonal Gammopathy – A disorder of the blood in which most ofthe protein produced is from one antibody instead of from many.
• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Multiple Myeloma – a malignancy of plasma cells derived from B-lymphocytes.
• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Multiple Sclerosis – A progressive disease of the central nervoussystem in which the protective covering of nerve fibers in the brain orspinal cord is destroyed.
• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Muscular Dystrophy – A slow, progressive disease characterized bydegeneration of muscle fibers.
• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Myasthenia Gravis – An autoimmune disorder in which the musclesbecome weak and tire easily.
• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Myasthenia Syndrome (see Lambert-Eaton Syndrome)
Myocardial Infarction (see Heart Attack) – Insufficient blood supplyto the heart muscle.
Myocarditis – An inflammation of the heart muscle, which is due to aviral infection.
• acute, full recovery, not related to any otherhealth condition . . . . . . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED
NNarcolepsy – A rare syndrome of recurrent attacks of sleep, suddenloss of muscle tone and sleep paralysis.
• well controlled, no functional limitations . . . .SELECT PREFERRED
• with disability or hospitalizations . . . . . . . . . . . . . .UNINSURABLE
FOR PRODUCER USE ONLY. NOT FOR USE WITH THE PUBLIC.
35
Nephrectomy (removal of one kidney only)
• after 6 months, normal labs andkidney tests . . . . . . . . . . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED
• due to disease or unhealthy remaining kidney . . .UNINSURABLE
Nephrolithiasis (see Kidney Stones)
Nephrosclerosis – A kidney disorder in which the smallest arteries inthe kidneys are damaged.
• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Neurofibromatosis – A genetic disorder of the nervous system thatcauses tumors to form on the nerves anywhere in the body at any time.
• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Neurogenic Bladder – A urinary problem in which there is abnormalemptying of the bladder with subsequent retention or incontinence ofurine.
• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Neuropathy – An abnormal and degenerative state of the nervoussystem or nerves.
• mild, non progressive, no functional limitations . . . . .PREFERRED
• Progressive symptoms OR Requires adaptive devices orassistance with Activities, OR History of Falls OR Balanceproblem when walking OR under current evaluation
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Nursing Home Confinement
• within the last year . . . . . . . . . . . . . . . . . . . . . . . . . . . .POSTPONE
0Obsessive compulsive disorder (OCD) – A disorder characterized byrepetitive thoughts and behaviors.
• well controlled with goodongoing treatment . . . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED
FOR PRODUCER USE ONLY. NOT FOR USE WITH THE PUBLIC.
36
Organ Transplant (except Kidney) – The replacement of a diseasedorgan with a healthy one.
• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Organic Brain Syndrome – A disturbance of mental functioning due toa physical cause as opposed to a psychological cause.
• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Osteomyelitis – An acute or chronic bone infection caused by bacteria.
• acute with complete recoveryafter 6 months . . . . . . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED
• chronic or active or with functional limitations . . .UNINSURABLE
Osteoporosis – A reduction of bone mass, causing bones to becomebrittle, fragile, and susceptible to fractures.
• mild, on medication, no history of fracture . .SELECT PREFERRED
• with fracture history . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Oxygen
• current use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
PPacemaker – An electrical device that can control the beating of theheart by a series of rhythmic electrical discharges.
• no complications . . . . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED
Paget’s Disease – A disruption of normal bone formation causing theaffected bones to weaken, thicken, and become deformed.
• if discovered on x-ray, no symptomsor fractures . . . . . . . . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED
• with fracture history . . . . . . . . . . . . . . . . . . . . . . . . . . .PREFERRED
• with severe joint deformity or pain . . . . . . . . . . . .UNINSURABLE
FOR PRODUCER USE ONLY. NOT FOR USE WITH THE PUBLIC.
37
Panic Disorder – Panic disorder is characterized by recurrent panicattacks (i.e., periods of intense fear and discomfort) on anunpredictable basis.
• medication as needed . . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED
• routine or daily medication taken . . . . . . . . . .SELECT PREFERRED
• with prior hospitalization(s) or disability . . . . . . . .UNINSURABLE
Pancreatitis – An inflammation of the pancreas.
• single episode, no residual, completerecovery after 6 months . . . . . . . . . . . . . . . . . .ULTRA PREFERRED
• Chronic or with multiple episodes ordue to alcohol . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Paralysis (all forms) – A complete or partial loss of controlledmovement caused by an inability to contract one or more muscles.
• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Parkinson’s Disease – A chronic progressive nervous disease markedby tremor, muscular weakness, rigidity and peculiar gait.
• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Pericarditis – A disorder caused by inflammation of the pericardium,which is the sac like covering of the heart.
• acute, full recovery, no other cardiac orrelated health condition . . . . . . . . . . . . . . . . . .ULTRA PREFERRED
Peripheral Neuropathy – A disease or degenerative state of theperipheral nerves marked by muscle weakness, atrophy, pain andnumbness.
• if caused by nerve root compression . . . . . . . . . . . . . .PREFERRED
• if caused by disease . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
FOR PRODUCER USE ONLY. NOT FOR USE WITH THE PUBLIC.
38
Peripheral Vascular Disease – A disease of the blood vesselscharacterized by narrowing and hardening of the arteries that supply thelegs and feet, causing a decrease in blood flow that can injure nervesand other tissues.
• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Phlebitis – Painful inflammation of a vein.
• single attack, fully recoveredafter 3 months . . . . . . . . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED
Physical Therapy
• within the last 6 months . . . . . . . . . . . . . . . . . . . . . . . .POSTPONE
Pick’s Disease – A rare degenerative brain illness that causesdementia and is marked by progressive impairment of intellectand judgment.
• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Pituitary Tumor, benign (see Brain tumor)
Polio – A virus which invades the central nervous system marked bytremor, muscle pain, muscle weakness, stiffness, serious breathingproblems, or death.
• history of, with full function,no past paralysis . . . . . . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED
• history of paralysis, now with full function . .SELECT PREFERRED
• with post polio syndrome or withcurrent residual paralysis . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Polycystic Kidney Disease – An inherited disease characterized bythe growth of numerous cysts filled with fluid in the kidneys.
• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Polycythemia – A blood disease with abnormal increase in red andwhite blood cells and platelets.
• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
FOR PRODUCER USE ONLY. NOT FOR USE WITH THE PUBLIC.
39
Polymyalgia Rheumatica – An inflammatory syndrome, which ismarked by pain and stiffness in the muscles of the hips, thighs,shoulders and neck.
• No symptoms and controlled with medication,in remission, No ongoing steroid use,No functional limits . . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED
• controlled with low dose steroid medications . . . . . . .PREFERRED
• with symptoms, frequent narcotic use,with functional limitations . . . . . . . . . . . . . . . . . . .UNINSURABLE
Polyps – A tumor, which is commonly found in vascular organs such asthe nose, uterus, colon, and rectum.
• surgically removed, benign . . . . . . . . . . . . . . . .ULTRA PREFERRED
• malignant . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .See Cancer
Post Traumatic Stress disorder – A psychiatric disorder that canoccur following a traumatic experience, a life threatening, or extremelydistressing situation that causes a person to feel intense fear, horror ora sense of helplessness.
• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Prostate Cancer (see Cancer)
Prostate Enlargement
• benign prostate hypertrophy (BPH), withor without surgery . . . . . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED
PSA (Elevated) (Prostate-Specific Antigen) – An enzyme that isproduced by the prostate gland that can be measured in the blood.
• Elevated, proven benign by biopsy, BPH treatedwith 1 medication or no medications . . . . . . . .ULTRA PREFERRED
• if rising, not within normal limits for age ornot proven benign . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
• elevated, no biopsy done, monitoring . . . . . . . . . . . . . .POSTPONE
FOR PRODUCER USE ONLY. NOT FOR USE WITH THE PUBLIC.
40
Psoriatic Arthritis – Pain and swelling of joints with patches of scalyskin related to psoriasis.
• no functional limits, no joint deformities, treatedwith 1 medication (not steroids) . . . . . . . . . . .SELECT PREFERRED
• moderate impairment, no functional limits, treated withsteroids, Methotrexate, Embrel, Plaquenil or similar medications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .PREFERRED
• severe joint deformity, ongoing pain, treated withnarcotics, with functional limitations . . . . . . . . . . .UNINSURABLE
Psychosis – A severe mental disorder in which the individual losescontact with reality.
• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Pulmonary Embolism – A blockage in an artery in the lungs caused bya blood clot that travels through the blood vessels to the lungs.
• one occurrence, no complications,off all blood thinners . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED
• recurrent, multiple . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Pulmonary Fibrosis – Scarring or thickening of tissues deep in the lungusually resulting from previous lung inflammation such as pneumonia, ortuberculosis.
• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
RRaynaud’s Disease – A disorder of the small blood vessels of theextremities, is characterized by intermittent pallor, blanching andcoldness of the affected parts.
• mild, non-progressive, with orwithout medications . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED
• progressive or with functional limitations . . . . . . .UNINSURABLE
FOR PRODUCER USE ONLY. NOT FOR USE WITH THE PUBLIC.
41
Raynaud’s Phenomenon – A circulatory disorder with similar signsand symptoms of Raynaud’s disease.
• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED
• due to serious underlying disease . . . . . . . . . . . . .UNINSURABLE
Reflex Sympathetic Dystrophy – A chronic pain condition that is theresult of dysfunction in the central or peripheral nervous system.
• Current, mild degree of impairment,no functional limitations . . . . . . . . . . . . . . . . .SELECT PREFERRED
Renal Failure – A gradual and progressive loss of the ability of thekidneys to excrete waste, concentrate urine, and conserve electrolytes.
• current . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
• acute, after 1 year, fully recovered,no residuals . . . . . . . . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED
• chronic renal insufficiency . . . . . . . . . . . . . . . . . . . . . .PREFERRED
Renal Insufficiency (not chronic) – Insufficient excretion of wastesby the kidneys.
• after 12 months, stable . . . . . . . . . . . . . . . . . .SELECT PREFERRED
Restless Leg Syndrome – A neurological disorder characterized byunpleasant sensations in the legs and an uncontrollable desire tomove them.
• controlled on one medication . . . . . . . . . . . . .SELECT PREFERRED
• multiple medications or use ofanti-Parkinson’s medications . . . . . . . . . . . . . . . . . . . .PREFERRED
Retinal Artery Occlusion – A blockage of the main artery leading tothe retina or one of it’s branches.
• after 2 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .PREFERRED
• within 2 years or multiple episodes . . . . . . . . . . . .UNINSURABLE
Retinitis Pigmentosa – A condition characterized by a degeneration ofthe rods and cones of the retina of the eye, which leads to blindness.
• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
FOR PRODUCER USE ONLY. NOT FOR USE WITH THE PUBLIC.
42
Retinopathy (Diabetic) – A disease of the retina due to diabetes thatcan cause decreased vision and blindness.
• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Rheumatoid Arthritis (see Arthritis) – A chronic systemic diseasemarked by inflammatory changes in the joints.
SSarcoidosis – A chronic multisystem disease of unknown causecharacterized by inflammatory cells, called granulomas that can producemany different symptoms.
• no progression for at least 1 year, mild symptoms,no treatment, non-cigarette smoker . . . . . . . .SELECT PREFERRED
• with current (or within past 12 months) cigarettesmoking or progressive . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Schizophrenia – A mental disorder that makes it difficult to tell thedifference between real and imagined experiences, to think logically, orto behave appropriately in social situations.
• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Scleroderma (Crest Syndrome) – An autoimmune disorder of theconnective tissue, which is characterized by formation of scar tissue inthe skin and organs of the body.
• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Scoliosis – A crookedness or lateral curvature of the spine.
• mild, no functional limitations . . . . . . . . . . . . .ULTRA PREFERRED
• severe but without physical limitations . . . . .SELECT PREFERRED
Seizure Disorder (see Epilepsy)
Self-Reported Memory Concerns
• current or within 5 years . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
FOR PRODUCER USE ONLY. NOT FOR USE WITH THE PUBLIC.
43
Shunts (Brain, Heart or Kidney) – A normal or abnormal passage bywhich bodily fluid is diverted from one channel, circulatory path, or partto another.
• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Shy-Drager Syndrome – A degenerative disease characterized byprogressive damage to the autonomic nervous system, muscle tremor,rigidity, and slow movement.
• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Sickle Cell Anemia – A hereditary disorder in which the red bloodcells contain an abnormal hemoglobin (protein carried by red cells),which results in blood cells shaped like sickles.
• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Sjogren’s Syndrome – A chronic disease in which white blood cellsattack the moisture producing glands, but it is a systemic disease,affecting many organs and may cause fatigue.
• mild, no limitations . . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED
• with disability or physical limitations . . . . . . . . . . .UNINSURABLE
Skin Cancer (not Melanoma) – Cancer that may arise on the surfaceof the body and form a small ulcer or pimple.
• external, basal or squamous cell cancer . . . . .ULTRA PREFERRED
Sleep Apnea – A breathing disorder characterized by brief interruptionsof breathing during sleep.
• Operated, Complete Recovery, No cardiac disease,Nonsmoker . . . . . . . . . . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED
• mild or currently using CPAP . . . . . . . . . . . . . .SELECT PREFERRED
• with cardiac disorder and/or overweight . . . . . . . . . . .PREFERRED
Smoking Cigarettes
• without medical problems . . . . . . . . . . . . . . . . . . .SELECT PREFERRED
• with chronic upper respiratory infections . . . . . . . . . . . . . .PREFERRED
• with diabetes, heart or lung disease . . . . . . . . . . . . . . .UNINSURABLE
FOR PRODUCER USE ONLY. NOT FOR USE WITH THE PUBLIC.
44
7Spinal Stenosis – A narrowing of the space in the spinal canalthrough which nerves run.
• mild, non-progressive . . . . . . . . . . . . . . . . . . .SELECT PREFERRED
• mild, multiple medications required,no functional limitations . . . . . . . . . . . . . . . . . . . . . . . .PREFERRED
Splenectomy – Surgical removal of the spleen due to traumaor disease.
• fully recovered . . . . . . . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED
Stent (cardiac) – A short or narrow metal plastic tube that isinserted into an artery or bile duct to keep a previously blockedpassageway open.
• after 6 months, with good results . . . . . . . . .SELECT PREFERRED
Stroke – A loss of brain functions caused by a loss of blood circulationto areas of the brain.
• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Subarachnoid Hemorrhage – A disorder in which blood from aruptured blood vessel spreads over the surface of the brain.
• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Subclavian Steal Syndrome – A condition characterized by recurrentattacks of blurred or double vision, dizziness and loss of coordinationcaused by reduced blood flow to the base of the brain.
• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Subdural Hematoma – A collection of blood between the surface ofthe brain and its outer covering.
• within 2 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .POSTPONE
• after 2 years, no residuals . . . . . . . . . . . . . . .SELECT PREFERRED
Suicide Attempt – The unsuccessful act of ending one’s own life.
• all . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Surgery Anticipated . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .POSTPONE
FOR PRODUCER USE ONLY. NOT FOR USE WITH THE PUBLIC.
45
TTemporal Arteritis – A chronic inflammation of large arteries, typicallyof the temporal artery, an artery on the side of the scalp.
• 1 year after recovery . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED
• in remission, currently taking Prednisoneor other steroid medication . . . . . . . . . . . . . . . . . . . . .PREFERRED
Temporomandibular Joint Syndrome (TMJ) – A dysfunction oralteration of the temporomandibular joint, which is the joint that allowsjaw mobility.
• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED
Thrombocythemia (elevated blood platelets) . . . . . .UNINSURABLE
Thrombocytopenic Purpura (low blood platelets) . .UNINSURABLE
TIA (Transient Ischemic Attack) – A brief interruption of the bloodsupply to a part of the brain.
• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Transverse Myelitis – A rare neurological disorder characterized byinflammation of the spinal cord.
• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Tremors – Involuntary movements in the muscles of the hands, arms,and head but can affect the legs.
• Benign, Essential, Intention or Familial, Must bestable for 6 months with no progression and normalneurological Exam . . . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED
U - ZUlcers (Duodenal or Peptic) – An erosion of the inner lining of thestomach usually caused by gastric acid and pepsin.
• history of, occasional medication . . . . . . . . . . .ULTRA PREFERRED
• chronic, frequent flare ups and/or bleeding . .SELECT PREFERRED
• surgery scheduled . . . . . . . . . . . . . . . . . . . . . . . . . . . . .POSTPONE
FOR PRODUCER USE ONLY. NOT FOR USE WITH THE PUBLIC.
46
Varicose Veins – Enlarged, twisted, painful superficial veins resultingfrom poorly functioning valves.
• uncomplicated, without medication . . . . . . . . .ULTRA PREFERRED
• medication required or with skin ulcers . . . . .SELECT PREFERRED
• with FUNCTIONAL LIMITATIONS or other complications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Vertebral Basilar Insufficiency – A condition in which blood flow tothe vertebral arteries is restricted or insufficient.
• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Vertigo – A type of dizziness that is characterized by the sensationof spinning.
• controlled with medication . . . . . . . . . . . . . . .SELECT PREFERRED
• not controlled . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Von Willebrand’s Disease – An inherited disorder of the blood, whichleads to abnormal bleeding.
• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Waldenstrom’s Disease – Excessive production of red blood cells,white blood cells, and platelets in the bone marrow.
• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Wilson’s Disease – An inherited disorder in which excessive amountsof copper accumulate in the body.
• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE
Wolf-Parkinson-White Syndrome – An abnormal heart rhythmcausing increased heart rate.
• asymptomatic, no medication, and/or successfully treated byradiofrequency ablation . . . . . . . . . . . . . . . . . .ULTRA PREFERRED
• episodes of tachycardia or treatedwith medication . . . . . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED
FOR PRODUCER USE ONLY. NOT FOR USE WITH THE PUBLIC.
47
AA.
Z.T.
Azid
othy
mid
ine
HIV
Infe
ctio
nAn
tiret
rovir
alNo
t Ins
urab
leAb
ilify
Depr
essio
nAn
ti Ps
ycho
ticNo
t Ins
urab
leAc
amro
sate
Alco
holis
mNo
t Ins
urab
leAc
cola
teZa
firlu
kast
Resp
irato
ryAn
tiast
hmat
ic, B
ronc
hodi
lato
rOt
her t
han
Ultra
Accu
Neb
Albu
tero
lRe
spira
tory
Bron
chod
ilato
rOt
her t
han
Ultra
Accu
pril
Quin
april
Card
iac
Antih
yper
tens
iveUs
ually
Ultr
aAc
curb
ron
Theo
phyll
ine
Resp
irato
ryBr
onch
odila
tor
Othe
r tha
n Ul
traAc
tiqFe
ntan
ylNa
rcot
ic Pa
in M
edica
tion
Opio
id A
nalg
esic
Not I
nsur
able
Acto
nel
Rise
dron
ate
Oste
opor
osis,
Pag
et’s
Bone
Res
orpt
ion
Inhi
bito
rOt
her t
han
Ultra
Acto
sPi
oglit
azon
e(N
IDDM
)An
tidia
betic
Othe
r tha
n Ul
traAc
tron
Keto
prof
enAr
thrit
is, P
ain
NSAI
DOt
her t
han
Ultra
Acyc
lovir
Acyc
lovir
Herp
es In
fect
ions
Antiv
iral
Usua
lly U
ltra
Adal
atNi
fedi
pine
Card
iac-
Calci
um C
hann
el B
lock
erAn
tiang
inal
, Ant
ihpe
rtens
ives
Othe
r tha
n Ul
traAd
enoc
ard
Aden
osin
eCa
rdia
cAn
tiarrh
ythm
icOt
her t
han
Ultra
Adde
rall
Atte
ntio
n De
ficit
Diso
rder
Usua
lly U
ltra
Adria
myc
inDo
xoru
bicin
Hyd
roch
lorid
eCa
ncer
Antin
eopl
astic
Not I
nsur
able
Adva
irFlu
ticas
one/
Salm
eter
ol C
ombo
Resp
irato
ryOt
her t
han
Ultra
Advil
Ibup
rofe
nAr
thrit
is, P
ain
NSAI
DOt
her t
han
Ultra
Aero
bid-
M In
hale
rFlu
niso
lide
Inha
ler
Resp
irato
ry In
hale
rCo
rtico
rste
roid
Inha
ler,
Antia
sthm
atic
Othe
r tha
n Ul
traAg
ener
ase
HIV
Not I
nsur
able
Aggr
enox
ASA/
Dipy
rimad
ole
Cicu
latio
nAn
tipla
tele
t Age
ntOt
her t
han
Ultra
Agry
linTh
rom
bocy
tope
nia
Not I
nsur
able
FOR
PROD
UCER
USE
ON
LY. N
OT F
OR U
SE W
ITH
THE
PUBL
IC.
48
500
Serie
s Pr
escr
iptio
n Dr
ug G
uide
Drug
-Gen
eric
Ge
neric
Nam
eDe
scrip
tion/
Ther
apeu
tic C
lass
Prob
able
Act
ion
& T
rade
Nam
esCo
nditi
ons
Trea
ted
A-hy
rdro
Cort
Hydr
ocor
tison
eSt
eroi
dAn
tiast
hmat
ic, C
ortic
oste
roid
Othe
r tha
n Ul
traAi
ret
Albu
tero
lRe
spira
tory
Bron
chod
ilato
rOt
her t
han
Ultra
Akin
eton
Bipe
riden
Park
inso
n‚An
tipar
kinso
nNo
t Ins
urab
leAl
bute
rol
Albu
tero
lRe
spira
tory
Bron
chod
ilato
rOt
her t
han
Ultra
Alca
rDe
men
tiaNo
t Ins
urab
leAl
dact
azid
ee
Com
boCa
rdia
c, Ed
ema
Antih
yper
tens
ive, D
iure
ticUs
ually
Ultr
aAl
dact
one
Spiro
nola
cton
eEd
ema
Diur
etic,
Pot
assiu
m-S
parin
gUs
ually
Ultr
aAl
dazin
eAn
ti Ps
ycho
ticNo
t Ins
urab
leAl
dom
etM
ethy
ldop
aCa
rdia
cAn
tihyp
erte
nsive
Usua
lly U
ltra
Aldo
rilCo
mbo
Card
iac
Antih
yper
tens
iveUs
ually
Ultr
aAl
endr
onat
eAl
endr
onat
eOs
teop
oros
isBo
ne R
esor
ptio
n In
hibi
tors
Othe
r tha
n Ul
traAl
eve
Napr
oxen
Arth
ritis,
Pai
nNS
AID
Othe
r tha
n Ul
traAl
kera
nCa
ncer
Antin
eopl
astic
Not I
nsur
able
Allo
purin
olAl
lopu
rinol
Gout
Antig
out A
gent
Usua
lly U
ltra
Alm
otrip
tan
Alm
otrip
tan
Mig
rain
esVa
scul
ar H
eada
che
Supp
ress
ant
Usua
lly U
ltra
Alpr
azol
amAl
praz
olam
Anxie
ty-B
enzo
diaz
epin
eAn
tianx
iety
Othe
r tha
n Ul
traAl
tace
Ram
ipril
Card
iac
Antih
yper
tens
iveUs
ually
Ultr
aAl
upen
tM
etap
rote
reno
lRe
spira
tory
Inha
ler
Bron
chod
ilato
rOt
her t
han
Ultra
Aman
tadi
neAm
anta
dine
Park
inso
n, V
iral I
nfec
tions
Antip
arkin
son,
Ant
ivira
lNo
t Ins
urab
leAm
aryl
Glim
epiri
de(N
IDDM
)An
tidia
betic
Othe
r tha
n Ul
traAm
bien
Zolp
idem
Slee
ping
pill
Seda
tive/
Hypn
otic
Usua
lly U
ltra
Amco
rtTr
iam
cinol
one
Ster
oid
Antia
sthm
atic,
Cor
ticos
tero
idOt
her t
han
Ultra
Amer
geNa
ratri
ptan
Mig
rain
esVa
scul
ar H
eada
che
Supp
ress
ant
Usua
lly U
ltra
A-M
etha
pred
Met
hylp
redn
isolo
neSt
eroi
dAn
tiast
hmat
ic, C
ortic
oste
roid
Othe
r tha
n Ul
traAm
etho
pter
inM
etho
trexa
teRh
eum
atoi
d Ar
thrit
isDM
ARD,
Imm
unos
uppr
essa
ntOt
her t
han
Ultra
Amin
ophy
lline
Amin
ophy
lline
Resp
irato
ryBr
onch
odila
tor
Othe
r tha
n Ul
traAm
ioda
rone
Amio
daro
neCa
rdia
cAn
tiarrh
ythm
icsOt
her t
han
Ultra
Amitr
ipty
line
Amitr
ipty
line
Depr
essio
n, C
hron
ic Pa
inAn
tidep
ress
ant
Othe
r tha
n Ul
tra
FOR
PROD
UCER
USE
ON
LY. N
OT F
OR U
SE W
ITH
THE
PUBL
IC.
49
Drug
-Gen
eric
Ge
neric
Nam
eDe
scrip
tion/
Ther
apeu
tic C
lass
Prob
able
Act
ion
& T
rade
Nam
esCo
nditi
ons
Trea
ted
Amlo
dipi
neAm
lodi
pine
Card
iac-
Calci
um C
hann
el B
lock
erAn
tihyp
erte
nsive
Usua
lly U
ltra
Anaf
lex
Salsa
late
Arth
ritis,
Pai
nNS
AID
Othe
r tha
n Ul
traAn
afra
nil
Clom
ipra
min
eDe
pres
sion
Antio
bses
sive
Agen
tOt
her t
han
Ultra
Anak
inra
Anak
inra
Rheu
mat
oid
Arth
ritis
DMAR
DOt
her t
han
Ultra
Anap
rox
Napr
oxen
Arth
ritis,
Pai
nNS
AID
Othe
r tha
n Ul
traAn
aspa
zHy
oscy
amin
eUr
inar
y, Ga
stro
inte
stin
alAn
tispa
smod
ic, A
ntich
olin
ergi
cUs
ually
Ultr
aAn
astra
zole
Anas
trazo
leBr
east
Can
cer
Antin
eopl
astic
Othe
r tha
n Ul
traAn
exsia
Hydr
ocod
one/
Acet
amin
ophe
nNa
rcot
ic Pa
in M
edica
tion
Opio
id A
nalg
esic
Not I
nsur
able
Ansa
idFlu
rbip
rofe
nAr
thrit
isNS
AID,
Ant
irheu
mat
icOt
her t
han
Ultra
Anta
buse
Alco
holis
mNo
t Ins
urab
leAn
tiver
tM
ecliz
ine
Mot
ion
Sick
ness
, Ver
tigo
Antie
met
ics, A
ntih
istam
ines
Othe
r tha
n Ul
traAp
o-Flu
rbip
rofe
nFlu
rbip
rofe
nAr
thrit
isNS
AID,
Ant
irheu
mat
icOt
her t
han
Ultra
Apok
ynPa
rkin
son’s
Anti
Park
inso
n’sNo
t Ins
urab
leAp
o-Se
legi
line
Sele
gilin
ePa
rkin
son
Antip
arkin
son
Not I
nsur
able
Apo-
Vera
pVe
rapa
mil
Card
iac-
Calci
um C
hann
el B
lock
erAn
tihyp
erte
nsive
, Vas
cula
r Hea
dach
esOt
her t
han
Ultra
Apre
solin
eHy
dral
azin
eCa
rdia
cAn
tihyp
erte
nsive
Othe
r tha
n Ul
traAp
tivus
Antir
etro
viral
Not I
nsur
able
Aran
esp
Inje
ctab
leDa
rbep
oetin
Anem
ia o
f Chr
onic
Rena
l Fai
lure
Anti-
Anem
icNo
t Ins
urab
leAr
ava
Leflu
nom
ide
Rheu
mat
oid
Arth
ritis
DMAR
DOt
her t
han
Ultra
Ared
iaPa
mid
rona
teHy
perc
alce
mia
, Pag
et’s
Bone
Res
orpt
ion
Inhi
bito
rOt
her t
han
Ultra
Arice
ptDo
nepe
zilM
emor
y Lo
ssAn
ti-Al
zhei
rmer
Not I
nsur
able
Arim
edex
Anas
trazo
leBr
east
Can
cer
Antin
eopl
astic
Othe
r tha
n Ul
traAr
istoc
ort
Tria
mcin
olon
eSt
eroi
dAn
tiast
hmat
ic, C
ortic
oste
roid
Othe
r tha
n Ul
traAr
mou
r Thy
roid
Thyr
oid
Thyr
oid
Prep
arat
ions
Horm
one
Usua
lly U
ltra
Arom
asin
Exem
esta
neCa
ncer
Antin
eopl
astic
Call
Arra
non
Canc
erLe
ukem
iaNo
t Ins
urab
leAr
tane
Trih
exyp
heni
dyl
Park
inso
nAn
tipar
kinso
nNo
t Ins
urab
leAr
thro
pan
Chol
ine
Salic
ylate
Arth
ritis
NSAI
DOt
her t
han
Ultra
FOR
PROD
UCER
USE
ON
LY. N
OT F
OR U
SE W
ITH
THE
PUBL
IC.
50
Drug
-Gen
eric
Ge
neric
Nam
eDe
scrip
tion/
Ther
apeu
tic C
lass
Prob
able
Act
ion
& T
rade
Nam
esCo
nditi
ons
Trea
ted
Arth
rote
cDi
clofe
nac/
Miso
pros
tol C
ombo
Arth
ritis
NSAI
D w
ith A
ntiu
lcer A
gent
Othe
r tha
n Ul
traAr
ticul
ose
Pred
niso
lone
Ster
oid
Antia
sthm
atic,
Cor
ticos
tero
idOt
her t
han
Ultra
Asac
olM
esal
amin
eGa
stro
inte
stin
al-U
lcera
tive
Colit
isGI
Ant
iinfla
mm
ator
yOt
her t
han
Ultra
Asce
ndin
Amox
apin
eDe
pres
sion
Antid
epre
ssan
tOt
her t
han
Ultra
Asm
alix
Theo
phyll
ine
Resp
irato
ryBr
onch
odila
tor
Othe
r tha
n Ul
traAs
para
gina
seCa
ncer
Leuk
emia
Not I
nsur
able
Asth
maH
aler
Mist
Epin
ephr
ine
Resp
irato
ryVa
sopr
esso
rsOt
her t
han
Ultra
Astra
mor
phM
orph
ine
Narc
otic
Pain
Med
icatio
nOp
ioid
Ana
lges
icNo
t Ins
urab
leAt
acan
dCa
ndes
arta
nHy
perte
nsio
nAn
tihyp
erte
nsive
Usua
lly U
ltra
Atam
epPa
rkin
son’s
Anti
Park
inso
nNo
t Ins
urab
leAt
arax
Hydr
oxyz
ine
Anxie
ty, It
chin
g, S
edat
ion
Antih
istam
ine
Usua
lly U
ltra
Aten
olol
Aten
olol
Card
iac-
Beta
Blo
cker
Antia
ngin
al, A
ntih
yper
tens
iveUs
ually
Ultr
aAt
epry
lPa
rkin
son’s
Anti
Park
inso
nNo
t Ins
urab
leAt
ivan
Lora
zepa
mAn
xiety
Antia
nxie
ty, S
edat
ive/H
ypno
ticOt
her t
han
Ultra
Atol
one
Tria
mcin
olon
eSt
eroi
dAn
tiast
hmat
ic, C
ortic
oste
roid
Othe
r tha
n Ul
traAt
orva
stat
inAt
orva
stat
inHy
perc
hole
ster
olem
iaLip
id-(f
at)-L
ower
ing
drug
Usua
lly U
ltra
Atre
tol
Carb
amaz
epin
eNe
ural
gia
Antic
onvu
lsant
Othe
r tha
n Ul
traAt
ripla
HIV
Antir
etro
viral
Not I
nsur
able
Atro
vent
Ipra
tropi
umRe
spira
tory
Inha
ler
Bron
chod
ilato
rOt
her t
han
Ultra
Aura
nofin
Gold
The
rapy
Arth
ritis
Othe
r tha
n Ul
traAv
andi
aRo
siglit
azon
e(N
IDDM
)An
tidia
betic
Othe
r tha
n Ul
traAv
apro
Irbes
arta
nHy
perte
nsio
nAn
tihyp
erte
nsive
Usua
lly U
ltra
Avas
tinCa
ncer
Canc
erOt
her t
han
Ultra
Aven
tyl
Nortr
ipty
line
Depr
essio
nAn
tidep
ress
ant
Othe
r tha
n Ul
traAv
onex
Mul
tiple
Scle
rosis
Mul
tiple
Scle
rosis
Not I
nsur
able
Axer
tAl
mot
ripta
nM
igra
ines
Vasc
ular
Hea
dach
e Su
ppre
ssan
tUs
ually
Ultr
aAz
athi
oprin
eM
ultip
le S
clero
sisM
ultip
le S
clero
sisNo
t Ins
urab
leAz
atho
prin
eAz
atho
prin
eAr
thrit
is, C
rohn
’sIm
mun
osup
pres
sant
Othe
r tha
n Ul
tra
FOR
PROD
UCER
USE
ON
LY. N
OT F
OR U
SE W
ITH
THE
PUBL
IC.
51
Drug
-Gen
eric
Ge
neric
Nam
eDe
scrip
tion/
Ther
apeu
tic C
lass
Prob
able
Act
ion
& T
rade
Nam
esCo
nditi
ons
Trea
ted
Azid
othy
mid
ine
Azid
othy
mid
ine
HIV
Infe
ctio
nAn
tiret
rovir
alNo
t Ins
urab
leAz
mac
ort
Tria
mcin
olon
e In
hale
rRe
spira
tory
Inha
ler
Corti
cors
tero
id In
hale
r, An
tiast
hmat
icOt
her t
han
Ultra
Azul
fidin
eSu
lfasa
lazin
eRh
eum
atoi
d Ar
thrit
is, C
rohn
’sDM
ARD,
GI A
ntiin
flam
mat
ory
Othe
r tha
n Ul
traAZ
THI
VAn
tiret
rovir
alNo
t Ins
urab
le
BBa
clofe
nBa
clofe
nLe
sions
Antis
past
icity
Age
ntNo
t Ins
urab
leBa
nfle
xOr
phen
adrin
eM
uscle
Spa
sms
Skel
etal
Mus
cle R
elax
ant
Othe
r tha
n Ul
traBe
clove
ntBe
clom
etha
sone
Inha
ler
Resp
irato
ry In
hale
rCo
rtico
rste
roid
Inha
ler,
Antia
sthm
atic
Othe
r tha
n Ul
traBe
naze
pril
Bena
zepr
ilCa
rdia
cAn
tihyp
erte
nsive
Usua
lly U
ltra
Bend
opa
Park
inso
n’sAn
ti Pa
rkin
son
Not I
nsur
able
Bent
ylDi
cyclo
min
eGa
stro
inte
stin
al-Ir
ritab
le B
owel
Antis
pasm
odic
Usua
lly U
ltra
Benz
tropi
neBe
nztro
pine
Park
inso
nAn
tipar
kinso
nNo
t Ins
urab
leBe
prid
ilBe
prid
ilCa
rdia
c-Ca
lcium
Cha
nnel
Blo
cker
Anti-
Angi
nal
Othe
r tha
n Ul
traBe
tam
etha
sone
Beta
met
haso
neSt
eroi
dAn
tiast
hmat
ic, C
ortic
oste
roid
Othe
r tha
n Ul
traBe
tapa
ceSo
talo
lCa
rdia
c-Be
ta B
lock
erAn
tiarrh
ythm
icOt
her t
han
Ultra
Beta
sero
nM
ultip
le S
clero
sisM
ultip
le S
clero
sisNo
t Ins
urab
leBe
than
ecol
Beth
anec
olUr
inar
y-Bl
adde
rUr
inar
y Tr
act S
timul
ant
Usua
lly U
ltra
Bext
raVa
ldec
oxib
Arth
ritis,
Pai
nNS
AID
Othe
r tha
n Ul
traBi
perid
enBi
perid
enPa
rkin
son
Antip
arkin
son
Not I
nsur
able
Blen
oxan
eCa
ncer
Canc
erNo
t Ins
urab
leBl
ocod
ren
Timol
olCa
rdia
c, Gl
auco
ma,
Mig
rain
esHe
adac
hes,
Antig
lauc
oma
Usua
lly U
ltra
Boni
neM
ecliz
ine
Mot
ion
Sick
ness
, Ver
tigo
Antie
met
ics, A
ntih
istam
ines
Othe
r tha
n Ul
traBo
niva
Oste
opor
osis
Oste
opor
osis
Othe
r tha
n Ul
traBo
tox
Cosm
etic
surg
ery,
Dysk
ines
iaUs
ually
Ultr
aBr
etha
ireTe
rbut
alin
eRe
spira
tory
Inha
ler
Bron
chod
ilato
rOt
her t
han
Ultra
Brev
iblo
cEs
mol
olCa
rdia
c-Be
ta B
lock
erAn
tiarrh
ythm
icOt
her t
han
Ultra
FOR
PROD
UCER
USE
ON
LY. N
OT F
OR U
SE W
ITH
THE
PUBL
IC.
52
Drug
-Gen
eric
Ge
neric
Nam
eDe
scrip
tion/
Ther
apeu
tic C
lass
Prob
able
Act
ion
& T
rade
Nam
esCo
nditi
ons
Trea
ted
Bria
cany
lRe
spira
tory
Resp
irato
ryOt
her t
han
Ultra
Brom
ocrip
tine
Park
inso
n’sPa
rkin
son’s
Dise
ase
Not I
nsur
able
Brov
ana
Resp
irato
ryRe
spira
tory
Othe
r tha
n Ul
traBu
deso
nide
Inha
ler
Bude
soni
de In
hale
rRe
spira
tory
Inha
ler
Corti
cors
tero
id In
hale
r, An
tiast
hmat
icOt
her t
han
Ultra
Bulsu
fan
Canc
erCa
ncer
Not I
nsur
able
Bum
exBu
met
anid
eEd
ema
Othe
r tha
n Ul
traBu
prop
ion
Bupr
opio
nDe
pres
sion,
Sm
okin
g Ce
ssat
ion
Anitd
epre
ssan
t, Sm
okin
g De
terra
ntOt
her t
han
Ultra
BuSp
arBu
spiro
neAn
xiety
Antia
nxie
tyOt
her t
han
Ultra
Byet
taDi
abet
esAn
ti di
abet
icOt
her t
han
Ultra
CCa
ferg
otEr
gota
min
e/Ca
ffein
e Co
mbo
Mig
rain
esVa
scul
ar H
eada
che
Supp
ress
ant
Usua
lly U
ltra
Cala
n SR
Vera
pam
ilCa
rdia
c-Ca
lcium
Cha
nnel
Blo
cker
Antih
yper
tens
ive, V
ascu
lar H
eada
ches
Othe
r tha
n Ul
traCa
lcito
nin
Calci
toni
nOs
teop
oros
is, P
aget
’sHy
poca
lcem
icOt
her t
han
Ultra
Cam
pral
Alco
holis
mAl
coho
lism
Not I
nsur
able
Capo
ten
Capt
opril
Card
iac
Antih
yper
tens
iveUs
ually
Ultr
aCa
psai
cinCa
psai
cinPa
in M
anag
emen
t, To
pica
lNo
nopi
oid
Anal
gesic
s (To
pica
l)Ot
her t
han
Ultra
Capt
opril
Capt
opril
Card
iac
Antih
yper
tens
iveUs
ually
Ultr
aCa
rafa
teSu
cral
fate
Gast
roin
test
inal
Antiu
lcer A
gent
Usua
lly U
ltra
Carb
acot
Met
hoca
rbam
olM
uscle
Spa
sms
Skel
etal
Mus
cle R
elax
ant
Othe
r tha
n Ul
traCa
rbam
azep
ine
Carb
amaz
epin
eNe
ural
gia
Antic
onvu
lsant
Othe
r tha
n Ul
traCa
rbat
rol
Carb
amaz
epin
eNe
ural
gia
Antic
onvu
lsant
Othe
r tha
n Ul
traCa
rbex
Sele
gilin
ePa
rkin
son
Antip
arkin
son
Not I
nsur
able
Carb
idop
aPa
rkin
son’s
Park
inso
n’s D
iseas
eNo
t Ins
urab
leCa
rden
eNi
card
ipin
eCa
rdia
c-Ca
lcium
Cha
nnel
Blo
cker
Antia
ngin
al, A
ntih
perte
nsive
sOt
her t
han
Ultra
Card
izem
Dilti
azem
Card
iac-
Calci
um C
hann
el B
lock
erAn
tihpe
rtens
ives
Usua
lly U
ltra
Card
ura
Doxa
zosin
Card
iac
Antih
yper
tens
iveUs
ually
Ultr
a
FOR
PROD
UCER
USE
ON
LY. N
OT F
OR U
SE W
ITH
THE
PUBL
IC.
53
Drug
-Gen
eric
Ge
neric
Nam
eDe
scrip
tion/
Ther
apeu
tic C
lass
Prob
able
Act
ion
& T
rade
Nam
esCo
nditi
ons
Trea
ted
Caris
opro
dol
Caris
opro
dol
Mus
cle S
pasm
sSk
elet
al M
uscle
Rel
axan
tOt
her t
han
Ultra
Carti
aXT
Dilti
azem
Card
iac-
Calci
um C
hann
el B
lock
erAn
tihpe
rtens
ives
Usua
lly U
ltra
Caso
dex
Canc
erAn
tineo
plas
ticNo
t Ins
urab
leCa
tafla
mDe
clofe
nac
Arth
ritis
NSAI
DOt
her t
han
Ultra
Cata
pres
Clon
idin
eCa
rdia
cAn
tihyp
erte
nsive
Usua
lly U
ltra
Cee
NuCa
ncer
Canc
erNo
t Ins
urab
leCe
lebr
exCe
leco
xibAr
thrit
isNS
AID,
Ant
irheu
mat
icOt
her t
han
Ultra
Cele
ston
eBe
tam
etha
sone
Ster
oid
Antia
sthm
atic,
Cor
ticos
tero
idOt
her t
han
Ultra
Cele
xaCi
talo
pram
Depr
essio
nAn
tidep
ress
ant
Othe
r tha
n Ul
traCe
lont
inCe
rebr
al A
rtery
Dise
ase
Not I
nsur
able
Ceph
ulac
Lact
ulos
eGa
stro
inte
stin
al-C
onst
ipat
ion
Laxa
tive
Usua
lly U
ltra
Ceru
bidi
neCa
ncer
Not I
nsur
able
Cevim
elin
eCe
vimel
ine
Sjog
ren’s
Syn
drom
eCh
olin
ergi
cOt
her t
han
Ultra
Chan
tixSm
okin
g Ce
ssat
ion
Othe
r tha
n Ul
traCh
lora
l Hyd
rate
Chlo
ral H
ydra
teSe
dativ
eSe
dativ
e/Hy
pono
ticOt
her t
han
Ultra
Chlo
ram
bucil
Chlo
ram
bucil
Canc
erAn
tineo
plas
tic, I
mm
unos
uppr
essa
ntNo
t Ins
urab
leCh
lord
iaze
poxid
eCh
lord
iaze
poxid
eAn
xiety
-Ben
zodi
azep
ine
Antia
nxie
ty, S
edat
ive/H
ypno
ticOt
her t
han
Ultra
Chlo
roth
iazid
eCh
loro
thia
zide
Card
iac,
Edem
aAn
tihyp
erte
nsive
, Diu
retic
Usua
lly U
ltra
Chlo
rpro
maz
ine
Chlo
rpro
maz
ine
Psyc
hose
sAn
tipsy
chot
ics, A
ntie
met
icNo
t Ins
urab
leCh
lorp
ropa
mid
eDi
abet
esAn
tidia
bete
sOt
her t
han
Ultra
Chlo
rthal
idon
eCh
lorth
alid
one
Card
iac,
Edem
aAn
tihyp
erte
nsive
, Diu
retic
Usua
lly U
ltra
Chol
esty
ram
ine
Chol
esty
ram
ine
Hype
rcho
lest
erol
emia
Lipid
-(fat
)-Low
erin
g dr
ugUs
ually
Ultr
aCh
olin
e Sa
licyla
teCh
olin
e Sa
licyla
teAr
thrit
isNS
AID
Othe
r tha
n Ul
traCh
ronu
lac
Lact
ulos
eGa
stro
inte
stin
al-C
onst
ipat
ion
Laxa
tive
Usua
lly U
ltra
Cilo
staz
olCi
lost
azol
Circ
ulat
ion
Antip
late
let A
gent
Not I
nsur
able
Cim
etid
ine
Cim
etid
ine
Gast
roin
test
inal
Antiu
lcer A
gent
Usua
lly U
ltra
Cin-
Quin
Quin
idin
e Su
lfate
Card
iac
Antia
rryth
mics
Othe
r tha
n Ul
traCi
spla
tinCa
ncer
Not I
nsur
able
FOR
PROD
UCER
USE
ON
LY. N
OT F
OR U
SE W
ITH
THE
PUBL
IC.
54
Drug
-Gen
eric
Ge
neric
Nam
eDe
scrip
tion/
Ther
apeu
tic C
lass
Prob
able
Act
ion
& T
rade
Nam
esCo
nditi
ons
Trea
ted
Clad
ribin
eLe
ukem
ia, M
ultip
le S
clero
sisAn
ti ne
opla
stic
Not I
nsur
able
Clar
inex
Deslo
rata
dine
Alle
rgie
s, Hi
ves
Antih
istam
ine
Usua
lly U
ltra
Clin
oril
Sulin
dac
Arth
ritis,
Pai
nNS
AID,
Ant
irheu
mat
icOt
her t
han
Ultra
Clon
azep
amCl
onaz
epam
Seizu
re D
isord
erAn
ticon
vulsa
ntOt
her t
han
Ultra
Clon
idin
eCl
onid
ine
Card
iac
Antih
yper
tens
iveUs
ually
Ultr
aCl
oraz
ilDe
pres
sion
Anti
psyc
hotic
Not I
nsur
able
Cloz
apin
eCl
ozap
ine
Schi
zoph
reni
aAn
tipsy
chot
icNo
t Ins
urab
leCo
dein
eCo
dein
eNa
rcot
ic Pa
in M
edica
tion
Opio
id A
nalg
esic
Call
Coge
ntin
Benz
tropi
nePa
rkin
son
Antip
arkin
son
Not I
nsur
able
Cogn
exTa
crin
eM
emor
y Lo
ssAn
ti-Al
zhei
rmer
Not I
nsur
able
Cola
zal
Balsa
lazid
eGa
stro
inte
stin
al: U
lcera
tive
Colit
isGI
Ant
iinfla
mm
ator
yUs
ually
Ultr
aCo
lchici
neCo
lchici
neGo
utAn
tigou
t Age
ntUs
ually
Ultr
aCo
lese
vela
mCo
lese
vela
mHy
perc
hole
ster
olem
iaLip
id-(f
at)-L
ower
ing
drug
Usua
lly U
ltra
Cole
stid
Cole
stip
olHy
perc
hole
ster
olem
iaLip
id-(f
at)-L
ower
ing
drug
Usua
lly U
ltra
Com
bipr
esCh
lorth
alid
one/
Clon
idin
e Co
mbo
Card
iac
Antih
yper
tens
iveUs
ually
Ultr
aCo
mbi
vent
Com
boRe
spira
tory
Inha
ler
Bron
chod
ilato
rOt
her t
han
Ultra
Com
pazin
ePr
ochl
orpe
razin
ePs
ycho
ses
Antie
met
ic, A
ntip
sych
otic
Not I
nsur
able
Com
tan
Enta
capo
nePa
rkin
son
Antip
arkin
son
Not I
nsur
able
Conc
erta
Atte
ntio
n De
ficit
Diso
rder
CNS
Stim
ulan
tUs
ually
Ultr
aCo
paxo
neM
ultip
le S
clero
sisim
mun
omod
ulto
rNo
t Ins
urab
leCo
rdro
lPr
edni
sone
Ster
oid
Antia
sthm
atic,
Cor
ticos
tero
idOt
her t
han
Ultra
Core
gCa
rved
ilol
Card
iac-
Bet
a Bl
ocke
rAn
tihyp
erte
nsive
Usua
lly U
ltra
Corg
ard
Nado
lol
Card
iac
Antia
ngin
al, A
ntih
yper
tens
iveOt
her t
han
Ultra
Corte
fHy
droc
ortis
one
Ster
oid
Antia
sthm
atic,
Cor
ticos
tero
idOt
her t
han
Ultra
Corti
sone
Corti
sone
Ster
oid
Antia
sthm
atic,
Cor
ticos
tero
idOt
her t
han
Ultra
Corto
neCo
rtiso
neSt
eroi
dAn
tiast
hmat
ic, C
ortic
oste
roid
Othe
r tha
n Ul
traCo
rver
tIb
utili
deCa
rdia
cAn
tiarrh
ythm
icsOt
her t
han
Ultra
Corzi
deCo
mbo
Card
iac
Antia
ngin
al, A
ntih
yper
tens
iveOt
her t
han
Ultra
FOR
PROD
UCER
USE
ON
LY. N
OT F
OR U
SE W
ITH
THE
PUBL
IC.
55
Drug
-Gen
eric
Ge
neric
Nam
eDe
scrip
tion/
Ther
apeu
tic C
lass
Prob
able
Act
ion
& T
rade
Nam
esCo
nditi
ons
Trea
ted
Coto
lone
Pred
niso
lone
Ster
oid
Antia
sthm
atic,
Cor
ticos
tero
idOt
her t
han
Ultra
Coum
adin
War
farin
Bloo
d Th
inne
rAn
ticoa
gula
ntOt
her t
han
Ultra
Cove
ra-H
SVe
rapa
mil
Card
iac-
Calci
um C
hann
el B
lock
erAn
tihyp
erte
nsive
, Vas
cula
r Hea
dach
esUs
ually
Ultr
aCo
zaar
Losa
rtan
Hype
rtens
ion
Antih
yper
tens
iveUs
ually
Ultr
aCr
ixiva
nHI
VAn
tiret
rovir
alNo
t Ins
urab
leCr
omol
ynCr
omol
ynRe
spira
tory
Inha
ler/N
ebul
izer
Alle
rgy,
Antia
sthm
atic
Usua
lly U
ltra
Cupr
imin
ePe
nicil
lam
ine
Rheu
mat
oid
Arth
ritis
DMAR
D, Im
mun
osup
pres
sant
Othe
r tha
n Ul
traCy
clobe
nzap
rine
Cyclo
benz
aprin
eM
uscle
Spa
sms
Skel
etal
Mus
cle R
elax
ant
Othe
r tha
n Ul
traCy
cloph
osph
amid
eCa
ncer
Canc
erNo
t Ins
urab
leCy
close
rine
Alzh
eim
er’s
Alzh
eim
er's
Dise
ase
Not I
nsur
able
Cyclo
spor
ine
Cyclo
spor
ine
Arth
ritis,
Ulce
rativ
e Co
litis
Imm
unos
uppr
essa
ntOt
her t
han
Ultra
Cyle
rtPe
mol
ine
Stim
ulan
t, AD
HDCe
ntal
Ner
vous
Sys
tem
Stim
ulan
tUs
ually
Ultr
aCy
mba
ltaDe
pres
sion
Anti
Psyc
hotic
Not I
nsur
able
Cyst
ospa
zHy
oscy
amin
eUr
inar
y, Ga
stro
inte
stin
alAn
tispa
smod
ic, A
ntich
olin
ergi
cUs
ually
Ultr
aCy
tom
elLio
thyr
onin
eTh
yroi
d Pr
epar
atio
nsHo
rmon
eUs
ually
Ultr
aCy
tote
cM
isopr
osto
lGa
stro
inte
stin
al-P
reve
nt G
I ulce
rsAn
tiulce
r Age
ntUs
ually
Ultr
aCy
toxa
nCy
cloph
osph
amid
eCa
ncer
, Rhe
umat
oid
Arth
ritis
Imm
unos
uppr
essa
ntNo
t Ins
urab
le
DDa
lalo
neDe
xam
etha
sone
Ster
oid
Antia
sthm
atic,
Cor
ticos
tero
idOt
her t
han
Ultra
Dalm
ane
Flura
zepa
mSl
eepi
ng P
illSe
dativ
e/Hy
pnot
icUs
ually
Ultr
aDa
ntriu
mM
ultip
le S
clero
sisM
ultip
le S
clero
sisNo
t Ins
urab
leDa
ntro
lene
Cere
bral
Pal
syAn
ti sp
asm
odic
Not I
nsur
able
Darv
ocet
-NPr
opox
yphe
ne/A
ceta
min
ophe
nNa
rcot
ic Pa
in M
edica
tion
Opio
id A
nalg
esic
Call
Darv
onPr
opox
yphe
neNa
rcot
ic Pa
in M
edica
tion
Opio
id A
nalg
esic
Call
Dayp
roOx
apro
zinAr
thrit
is, P
ain
NSAI
D, A
ntirh
eum
atic
Othe
r tha
n Ul
traDe
cadr
onDe
xam
etha
sone
Ster
oid
Antia
sthm
atic,
Cor
ticos
tero
idOt
her t
han
Ultra
FOR
PROD
UCER
USE
ON
LY. N
OT F
OR U
SE W
ITH
THE
PUBL
IC.
56
Drug
-Gen
eric
Ge
neric
Nam
eDe
scrip
tion/
Ther
apeu
tic C
lass
Prob
able
Act
ion
& T
rade
Nam
esCo
nditi
ons
Trea
ted
Declo
fena
cDe
clofe
nac
Arth
ritis
NSAI
DOt
her t
han
Ultra
Dela
virdi
neDe
lavir
dine
HIV
Infe
ctio
nAn
tiret
rovir
alNo
t Ins
urab
leDe
mad
exTo
rsem
ide
Edem
aDi
uret
icOt
her t
han
Ultra
Dem
erol
Mep
erid
ine
Narc
otic
Pain
Med
icatio
nOp
ioid
Ana
lges
icCa
llDe
pake
neVa
lpro
ic Ac
idSe
izure
Diso
rder
Antic
onvu
lsant
, Vas
cula
r Hea
dach
esOt
her t
han
Ultra
Depa
kote
Diva
lpro
ex S
odiu
mSe
izure
Diso
rder
Antic
onvu
lsant
, Vas
cula
r Hea
dach
esOt
her t
han
Ultra
Depo
Med
rol
Met
hylp
redn
isolo
neSt
eroi
dAn
tiast
hmat
ic, C
ortic
oste
roid
Othe
r tha
n Ul
traDe
poni
tNi
togl
ycer
inCa
rdia
c-Ni
trate
Anti-
Angi
nal
Othe
r tha
n Ul
traDe
po P
rove
raCa
ncer
Canc
erNo
t Ins
urab
leDe
pryn
elDe
men
tia, P
arkin
son’s
Anti
Park
inso
n’sNo
t Ins
urab
leDe
sCa
ncer
Canc
erNo
t Ins
urab
leDe
sipra
min
eDe
sipra
min
eDe
pres
sion
Antid
epre
ssan
tOt
her t
han
Ultra
Desy
rel
Traz
odon
eDe
pres
sion
Antid
epre
ssan
tOt
her t
han
Ultra
Detro
lTo
ltero
dine
Urin
ary-
Blad
der
Antic
holin
ergi
cUs
ually
Ultr
aDe
xedr
ine
Dext
roam
phet
amin
eSt
imul
ant,
ADHD
, Nar
cole
psy
Cent
al N
ervo
us S
yste
m S
timul
ant
Othe
r tha
n Ul
traDi
aBet
aGl
ybur
ide
(NID
DM)
Antid
iabe
ticOt
her t
han
Ultra
Diab
ines
eDi
abet
es N
DDM
Antid
iabe
tes
Othe
r tha
n Ul
traDi
azep
amDi
azep
amRe
laxa
ntAn
ticon
vulsa
ntOt
her t
han
Ultra
Didr
onel
Etid
rona
teOs
teop
oros
is, P
aget
’sHy
poca
lcem
icOt
her t
han
Ultra
Diflu
can
Fluco
nazo
leFu
ngal
Infe
ctio
nsAn
tifun
gal
Usua
lly U
ltra
Digo
xinDi
goxin
Card
iac
Anth
arrh
ythm
icOt
her t
han
Ultra
Dihy
droe
rgot
amin
eDi
hydr
oerg
otam
ine
Mig
rain
esVa
scul
ar H
eada
che
Supp
ress
ant
Usua
lly U
ltra
Dila
cor X
RDi
ltiaz
emCa
rdia
c-Ca
lcium
Cha
nnel
Blo
cker
Antih
perte
nsive
sUs
ually
Ultr
aDi
lant
inPh
enyt
oin
Seizu
re D
isord
erAn
tiarry
thm
ic, A
ntico
nvul
sant
Othe
r tha
n Ul
traDi
latra
te-S
RIso
sorb
ide
Dini
trate
Card
iac-
Nitra
teAn
ti-An
gina
lOt
her t
han
Ultra
Dilti
azem
Dilti
azem
Card
iac-
Calci
um C
hann
el B
lock
erAn
tihpe
rtens
ives
Usua
lly U
ltra
Diov
anVa
lsarta
nHy
perte
nsio
nAn
tihpe
rtens
iveUs
ually
Ultr
aDi
phen
ylhyd
anto
inPh
enyt
oin
Seizu
re D
isord
erAn
tiarry
thm
ic, A
ntico
nvul
sant
Othe
r tha
n Ul
tra
FOR
PROD
UCER
USE
ON
LY. N
OT F
OR U
SE W
ITH
THE
PUBL
IC.
57
Drug
-Gen
eric
Ge
neric
Nam
eDe
scrip
tion/
Ther
apeu
tic C
lass
Prob
able
Act
ion
& T
rade
Nam
esCo
nditi
ons
Trea
ted
Dipy
rimad
ole
Dipy
rimad
ole
Circ
ulat
ory
Antip
late
let A
gent
Not I
nsur
able
Disa
lcid
Salsa
late
Arth
ritis,
Pai
nNS
AID
Othe
r tha
n Ul
traDi
sopy
ram
ide
Diso
pyra
mid
eCa
rdia
cAn
tiarrh
ythm
icOt
her t
han
Ultra
Ditro
pan
Oxyb
utyn
inUr
inar
y-Bl
adde
rAn
ticho
liner
gic
Usua
lly U
ltra
Diur
ilCh
loro
thia
zide
Card
iac,
Edem
aAn
tihyp
erte
nsive
, Diu
retic
Usua
lly U
ltra
Diva
lpro
ex S
odiu
mDi
valp
roex
Sod
ium
Seizu
re D
isord
erAn
ticon
vulsa
nt, V
ascu
lar H
eada
ches
Othe
r tha
n Ul
traDi
zac
Diaz
epam
Rela
xant
Antic
onvu
lsant
Othe
r tha
n Ul
traDo
ceta
xel
Canc
erCa
ncer
Not I
nsur
able
Dolo
phin
eM
etha
done
Narc
otic
Pain
Med
icatio
nOp
ioid
Ana
lges
icNo
t Ins
urab
leDo
lora
cCa
psai
cinPa
in M
anag
emen
t, To
pica
lNo
nopi
oid
Anal
gesic
s (To
pica
l)Ot
her t
han
Ultra
Done
pezil
Done
pezil
Mem
ory
Loss
Anti-
Alzh
eirm
erNo
t Ins
urab
leDo
nnam
arHy
oscy
amin
eUr
inar
y, Ga
stro
inte
stin
alAn
tispa
smod
ic, A
ntich
olin
ergi
cUs
ually
Ultr
aDo
nnat
alne
/Sco
pola
min
e Co
mbo
Gast
roin
test
inal
Gast
roin
test
inal
Usua
lly U
ltra
Dopa
rLe
vodo
paPa
rkin
son’s
Antip
arkin
son
Not I
nsur
able
Doxa
zosin
Doxa
zosin
Card
iac
Antih
yper
tens
iveUs
ually
Ultr
aDo
xepi
nDo
xepi
nDe
pres
sion
Antia
nxie
ty, A
ntid
epre
ssan
tOt
her t
han
Ultra
DPH
Phen
ytoi
nSe
izure
Diso
rder
Antia
rryth
mic,
Ant
iconv
ulsa
ntOt
her t
han
Ultra
Drox
iaHy
drox
yure
aCa
ncer
Antin
eopl
astic
Not I
nsur
able
Duph
alac
Lact
ulos
eGa
stro
inte
stin
al-C
onst
ipat
ion
Laxa
tive
Usua
lly U
ltra
Dura
clon
Clon
idin
eCa
rdia
cAn
tihyp
erte
nsive
Usua
lly U
ltra
Dura
gesic
Fent
anyl
Tran
sder
mal
Opio
id A
nalg
esic
Not I
nsur
able
Dura
lone
Met
hylp
redn
isolo
neSt
eroi
dAn
tiast
hmat
ic, C
ortic
oste
roid
Othe
r tha
n Ul
traDu
ram
orph
Mor
phin
eNa
rcot
ic Pa
in M
edica
tion
Opio
id A
nalg
esic
Not I
nsur
able
Duvo
idBe
than
ecol
Urin
ary-
Blad
der
Urin
ary
Trac
t Stim
ulan
tUs
ually
Ultr
aDy
azid
eHy
droc
hlor
othi
azid
e/Tr
iam
tere
neCa
rdia
cAn
tihyp
erte
nsive
Usua
lly U
ltra
Dyna
Circ
Israd
ipin
eCa
rdia
c-Ca
lcium
Cha
nnel
Blo
cker
Antia
ngin
al, A
ntih
yper
tens
iveOt
her t
han
Ultra
Dym
elor
Diab
etes
Anti
diab
etic
Othe
r tha
n Ul
traDy
reni
umTr
iam
tere
neEd
ema
Diur
etic,
Pot
assiu
m-S
parin
gOt
her t
han
Ultra
FOR
PROD
UCER
USE
ON
LY. N
OT F
OR U
SE W
ITH
THE
PUBL
IC.
58
Drug
-Gen
eric
Ge
neric
Nam
eDe
scrip
tion/
Ther
apeu
tic C
lass
Prob
able
Act
ion
& T
rade
Nam
esCo
nditi
ons
Trea
ted
EEd
ur-A
cinNi
acin
Hype
rcho
lest
erol
emia
, Sup
plem
ent
Lipid
-(fat
)-Low
erin
g dr
ug, V
itam
inUs
ually
Ultr
aEf
fexo
rVe
nlaf
axin
eDe
pres
sion
Antia
nxie
ty, A
ntid
epre
ssan
tOt
her t
han
Ultra
Elav
ilAm
itrip
tylin
eDe
pres
sion,
Chr
onic
Pain
Antid
epre
ssan
tOt
her t
han
Ultra
Elde
pryl
Sele
gilin
ePa
rkin
son‚
Äôs
Antip
arkin
son
Not I
nsur
able
Elixo
phyll
inTh
eoph
yllin
eRe
spira
tory
Bron
chod
ilato
rOt
her t
han
Ultra
Emcy
tCa
ncer
Antin
eopl
astic
Not I
nsur
able
Emtri
vaHI
VAn
tere
trovir
alNo
t Ins
urab
leEn
alap
ril/E
nala
prila
tEn
alap
ril/E
nala
prila
tCa
rdia
cAn
tihyp
erte
nsive
Usua
lly U
ltra
Enbr
elEt
aner
cept
Rheu
mat
oid
Arth
ritis
DMAR
DOt
her t
han
Ultra
Ende
pAm
itrip
tylin
eDe
pres
sion,
Chr
onic
Pain
Antid
epre
ssan
tOt
her t
han
Ultra
Endo
codo
neOx
ycod
one
Narc
otic
Pain
Med
icatio
nOp
ioid
Ana
lges
icNo
t Ins
urab
leEn
taca
pone
Enta
capo
nePa
rkin
son’s
Antip
arkin
son
Not I
nsur
able
Ento
cort
ECBu
deso
nide
Ster
oid
Antia
sthm
atic,
Cor
ticos
tero
idOt
her t
han
Ultra
Enul
ose
Lact
ulos
eGa
stro
inte
stin
al-C
onst
ipat
ion
Laxa
tive
Usua
lly U
ltra
Epito
lCa
rbam
azep
ine
Neur
algi
aAn
ticon
vulsa
ntOt
her t
han
Ultra
Epivi
rHI
VAn
tiret
rovir
alNo
t Ins
urab
leEp
oetin
Epoe
tinAn
emia
of C
hron
ic Re
nal F
ailu
reAn
ti-An
emic
Not I
nsur
able
Eptif
ibat
ide
Eptif
ibat
ide
Card
iac
Antip
late
let A
gem
tNo
t Ins
urab
leEr
gota
min
eEr
gota
min
eM
igra
ines
Vasc
ular
Hea
dach
e Su
ppre
ssan
tUs
ually
Ultr
aEr
gots
tat
Ergo
tam
ine
Mig
rain
esVa
scul
ar H
eada
che
Supp
ress
ant
Usua
lly U
ltra
Eryt
hrop
oiet
in-In
ject
able
Epoe
tinAn
emia
of C
hron
ic Re
nal F
ailu
reAn
ti-An
emic
Not I
nsur
able
Esid
rex
Hydr
ochl
orot
hiaz
ide
Card
iac,
Edem
aAn
tihyp
erte
nsive
, Diu
retic
Usua
lly U
ltra
Eska
lith
Lithi
umM
anic-
Depr
essio
nAn
timan
icNo
t Ins
urab
leEs
mol
olEs
mol
olCa
rdia
c-Be
ta B
lock
erAn
tiarrh
ythm
icOt
her t
han
Ultra
Esom
epra
zole
Esom
epra
zole
Gast
roin
test
inal
Aniu
lcer A
gent
Usua
lly U
ltra
FOR
PROD
UCER
USE
ON
LY. N
OT F
OR U
SE W
ITH
THE
PUBL
IC.
59
Drug
-Gen
eric
Ge
neric
Nam
eDe
scrip
tion/
Ther
apeu
tic C
lass
Prob
able
Act
ion
& T
rade
Nam
esCo
nditi
ons
Trea
ted
Estra
diol
Estra
diol
Estro
gen
Repl
acem
ent T
hera
pyHo
rmon
eUs
ually
Ultr
aEt
aner
cept
Etan
erce
ptRh
eum
atoi
d Ar
thrit
isDM
ARD
Othe
r tha
n Ul
traEt
hmoz
ine
Mor
icizin
eCa
rdia
cAn
tiarrh
ythm
icOt
her t
han
Ultra
Etid
rona
teEt
idro
nate
Oste
opor
osis,
Pag
et’s
Hypo
calce
mic
Othe
r tha
n Ul
traEu
lexin
Fluta
mid
eCa
ncer
Antin
eopl
astic
Not I
nsur
able
Eval
ose
Lact
ulos
eGa
stro
inte
stin
al-C
onst
ipat
ion
Laxa
tive
Usua
lly U
ltra
Evist
aRa
loxif
ene
Oste
opor
osis
Bone
Res
orpt
ion
Inhi
bito
rsOt
her t
han
Ultra
Evox
acCe
vimel
ine
Sjog
ren’s
Syn
drom
eCh
olin
ergi
cOt
her t
han
Ultra
Exel
onRi
vast
igm
ine
Alzh
eim
ers/
Mem
ory
Anti-
Alzh
eirm
erNo
t Ins
urab
le
FFe
lden
ePi
roxic
amAr
thrit
is, P
ain
NSAI
D, A
ntirh
eum
atic
Othe
r tha
n Ul
traFe
nofib
rate
Feno
fibra
teHy
perc
hole
ster
olem
iaLip
id-(f
at)-L
ower
ing
drug
Usua
lly U
ltra
Fent
anyl
Fent
anyl
Narc
otic
Pain
Med
icatio
nOp
ioid
Ana
lges
icNo
t Ins
urab
leFe
osol
Ferro
us S
ulfa
teIro
n-De
ficie
ncy
Anem
iaAn
ti-An
emic
Othe
r tha
n Ul
traFe
rgon
Ferro
us G
luco
nate
Iron-
Defic
ienc
y An
emia
Anti-
Anem
icOt
her t
han
Ultra
Ferro
us G
luco
nate
Ferro
us G
luco
nate
Iron-
Defic
ienc
y An
emia
Anti-
Anem
icOt
her t
han
Ultra
Ferro
us S
ulfa
teFe
rrous
Sul
fate
Iron-
Defic
ienc
y An
emia
Anti-
Anem
icOt
her t
han
Ultra
Fioric
etCo
mbo
Narc
otic
Pain
Med
icatio
nBa
rbitu
ates
Call
Fiorin
alBu
talb
ital/A
spiri
n/Ca
ffein
e Co
mbo
Narc
otic
Pain
Med
icatio
nCa
llFla
gyl
Met
roni
dazo
leIn
fect
ions
Agen
tUs
ually
Ultr
aFle
cain
ide
Fleca
inid
eCa
rdia
cAn
tiarrh
ythm
icOt
her t
han
Ultra
Flexe
rilCy
clobe
nzap
rine
Mus
cle S
pasm
sSk
elet
al M
uscle
Rel
axan
tOt
her t
han
Ultra
Flexo
nOr
phen
adrin
eM
uscle
Spa
sms
Skel
etal
Mus
cle R
elax
ant
Othe
r tha
n Ul
traFlo
vent
Flutic
ason
e In
hale
rRe
spira
tory
Inha
ler
Corti
cors
tero
id In
hale
r, An
tiast
hmat
icOt
her t
han
Ultra
Fluco
nazo
leFlu
cona
zole
Fung
al In
fect
ions
Antif
unga
lUs
ually
Ultr
aFlu
niso
lide
Fluni
solid
e In
hale
rRe
spira
tory
Inha
ler
Corti
cors
tero
id In
hale
r, An
tiast
hmat
icOt
her t
han
Ultra
FOR
PROD
UCER
USE
ON
LY. N
OT F
OR U
SE W
ITH
THE
PUBL
IC.
60
Drug
-Gen
eric
Ge
neric
Nam
eDe
scrip
tion/
Ther
apeu
tic C
lass
Prob
able
Act
ion
& T
rade
Nam
esCo
nditi
ons
Trea
ted
Fluox
etin
eFlu
oxet
ine
Depr
essio
nAn
tidep
ress
ant
Othe
r tha
n Ul
traFlu
phen
azin
eFlu
phen
azin
ePs
ycho
ses
Antip
sych
otic
Not I
nsur
able
Flura
zepa
mFlu
raze
pam
Slee
ping
Pill
Seda
tive/
Hypn
otic
Usua
lly U
ltra
Flurb
ipro
fen
Flurb
ipro
fen
Arth
ritis
NSAI
D, A
ntirh
eum
atic
Othe
r tha
n Ul
traFlu
tam
ide
Fluta
mid
eCa
ncer
Antin
eopl
astic
Not I
nsur
able
Flutic
ason
e In
hale
rFlu
ticas
one
Inha
ler
Resp
irato
ry In
hale
rCo
rtico
rste
roid
Inha
ler,
Antia
sthm
atic
Othe
r tha
n Ul
traFlu
vast
atin
Fluva
stat
inHy
perc
hole
ster
olem
iaLip
id-(f
at)-L
ower
ing
drug
Usua
lly U
ltra
Fluvo
xam
ine
Fluvo
xam
ine
Depr
essio
nAn
tidep
ress
ant
Othe
r tha
n Ul
traFo
late
Folic
Acid
Anem
ia, V
itam
inAn
ti-An
emic
Usua
lly U
ltra
Fole
xM
etho
trexa
teRh
eum
atoi
d Ar
thrit
isDM
ARD,
Imm
unos
uppr
essa
ntOt
her t
han
Ultra
Folic
Acid
Folic
Acid
Anem
ia, V
itam
inAn
ti-An
emic
Usua
lly U
ltra
Folvi
teFo
lic A
cidAn
emia
, Vita
min
Anti-
Anem
icUs
ually
Ultr
aFo
ndap
arin
uxFo
ndap
arin
uxDV
T Pr
ophy
laxis
Antic
oagu
lant
Othe
r tha
n Ul
traFo
rmot
erol
Form
oter
olRe
spira
tory
Inha
ler
Bron
chod
ilato
rOt
her t
han
Ultra
Forte
oOs
teop
oros
isBo
ne R
esor
ptio
n in
hibi
tors
Othe
r tha
n Ul
traFo
sam
axAl
endr
onat
eOs
teop
oros
isBo
ne R
esor
ptio
n In
hibi
tors
Othe
r tha
n Ul
traFr
ovat
ripta
nFr
ovat
ripta
nM
igra
ines
Vasc
ular
Hea
dach
e Su
ppre
ssan
tUs
ually
Ultr
aFu
rose
mid
eFu
rose
mid
eEd
ema
Diur
etic
Usua
lly U
ltra
Fuze
onHI
VAn
tere
trovir
alNo
t Ins
urab
le
FOR
PROD
UCER
USE
ON
LY. N
OT F
OR U
SE W
ITH
THE
PUBL
IC.
61
Drug
-Gen
eric
Ge
neric
Nam
eDe
scrip
tion/
Ther
apeu
tic C
lass
Prob
able
Act
ion
& T
rade
Nam
esCo
nditi
ons
Trea
ted
GGa
lant
amin
eGa
lant
amin
eAl
zhei
mer
s/M
emor
yAn
ti Al
zhei
mer
'sNo
t Ins
urab
leGe
mfib
rozil
Gem
fibro
zilHy
perc
hole
ster
olem
iaLip
id-(f
at)-L
ower
ing
drug
Usua
lly U
ltra
Gen-
Sele
gilin
eSe
legi
line
Park
inso
n’sAn
tipar
kinso
nNo
t Ins
urab
leGe
odon
Zipr
asid
one
Schi
zoph
reni
aAn
tipsy
chot
icNo
t Ins
urab
leGl
atira
mir
Acet
ate
Mul
tiple
Scle
rosis
Imm
unom
odul
ator
-MS
Not I
nsur
able
Glee
vicLe
ukem
iaNo
t Ins
urab
leGl
imep
iride
Glim
epiri
de(N
IDDM
)An
tidia
betic
Othe
r tha
n Ul
traGl
ipizi
deGl
ipizi
de(N
IDDM
)An
tidia
betic
Othe
r tha
n Ul
traGl
ucop
hage
Met
form
in(N
IDDM
)An
tidia
betic
Othe
r tha
n Ul
traGl
ucot
rol
Glip
izide
(NID
DM)
Antid
iabe
ticOt
her t
han
Ultra
Gluc
ovan
ceGl
ybur
ide/
Met
form
in C
ombo
(NID
DM)
Antid
iabe
ticOt
her t
han
Ultra
Glyb
urid
eGl
ybur
ide
(NID
DM)
Antid
iabe
ticOt
her t
han
Ultra
Glyc
opyr
rola
teGl
ycop
yrro
late
Gast
roin
test
inal
-Pep
tic U
lcer D
iseas
eAn
tispa
smod
ic, A
ntich
olin
ergi
cUs
ually
Ultr
aGl
ynas
eGl
ybur
ide
(NID
DM)
Antid
iabe
ticOt
her t
han
Ultra
Glys
etM
iglit
ol(N
IDDM
)An
tidia
betic
Othe
r tha
n Ul
tra
HHa
lope
ridol
Halo
perid
olPs
ycho
ses
Antip
sych
otic
Not I
nsur
able
HCTZ
Hydr
ochl
orot
hiaz
ide
Card
iac,
Edem
aAn
tihyp
erte
nsive
, Diu
retic
Usua
lly U
ltra
Hepa
rin In
ject
able
Hepa
rin In
ject
able
Bloo
d Th
inne
rAn
ticoa
gula
ntNo
t Ins
urab
leHe
ptal
acLa
ctul
ose
Gast
roin
test
inal
-Con
stip
atio
nLa
xativ
eUs
ually
Ultr
aHe
xadr
olDe
xam
etha
sone
Ster
oid
Antia
sthm
atic,
Cor
ticos
tero
idOt
her t
han
Ultra
Hexa
len
Canc
erAn
tineo
plas
ticNo
t Ins
urab
leHi
vidHI
VAn
tere
trovir
alNo
t Ins
urab
leHy
dorm
orph
one
Hydo
rmor
phon
eNa
rcot
ic Pa
in M
edica
tion
Opio
id A
nalg
esic
Not I
nsur
able
FOR
PROD
UCER
USE
ON
LY. N
OT F
OR U
SE W
ITH
THE
PUBL
IC.
62
Drug
-Gen
eric
Ge
neric
Nam
eDe
scrip
tion/
Ther
apeu
tic C
lass
Prob
able
Act
ion
& T
rade
Nam
esCo
nditi
ons
Trea
ted
Hydr
alaz
ine
Hydr
alaz
ine
Card
iac
Antih
yper
tens
iveUs
ually
Ultr
aHy
drea
Hydr
oxyu
rea
Canc
erAn
tineo
plas
ticNo
t Ins
urab
leHy
droc
etCo
mbo
Narc
otic
Pain
Med
icatio
nOp
ioid
Ana
lges
icNo
t Ins
urab
leHy
droc
hlor
othi
azid
eHy
droc
hlor
othi
azid
eCa
rdia
c, Ed
ema
Antih
yper
tens
ive, D
iure
ticUs
ually
Ultr
aHy
droc
odon
eHy
droc
odon
eNa
rcot
ic pa
in m
edica
tion
Opio
id A
nalg
esic
Not I
nsur
able
Hydr
ocor
tison
eHy
droc
ortis
one
Ster
oid
Antia
sthm
atic,
Cor
ticos
tero
idOt
her t
han
Ultra
Hydr
oDiu
rilHy
droc
hlor
othi
azid
eCa
rdia
c, Ed
ema
Antih
yper
tens
ive, D
iure
ticUs
ually
Ultr
aHy
drop
res
Com
boCa
rdia
cAn
tihyp
erte
nsive
Usua
lly U
ltra
Hydr
oxyu
rea
Hydr
oxyu
rea
Canc
erAn
tineo
plas
ticNo
t Ins
urab
leHy
drox
yzin
eHy
drox
yzin
eAn
xiety,
Itch
ing,
Sed
atio
nAn
tihist
amin
eUs
ually
Ultr
aHy
grot
onCh
lorth
alid
one
Card
iac,
Edem
aAn
tihyp
erte
nsive
, Diu
retic
Usua
lly U
ltra
Hylo
rel
Guan
adre
lCa
rdia
cAn
tihyp
erte
nsive
Usua
lly U
ltra
Hyos
cyam
ine
Hyos
cyam
ine
Urin
ary,
Gast
roin
test
inal
Antis
pasm
odic,
Ant
ichol
iner
gic
Usua
lly U
ltra
Hytri
nTe
razo
sinCa
rdia
c, Pr
osta
te E
nlar
gem
ent
Antih
yper
tens
ive, B
PHUs
ually
Ultr
aHy
zine-
50Hy
drox
yzin
eAn
xiety,
Itch
ing,
Sed
atio
nAn
tihist
amin
eUs
ually
Ultr
a
IIb
upro
fen
Ibup
rofe
nAr
thrit
isNS
AID
Othe
r tha
n Ul
traIb
utili
deIb
utili
deCa
rdia
cAn
tiarrh
ythm
icsOt
her t
han
Ultra
Imdu
rIso
sorb
ide
Mon
onitr
ate
Card
iac-
Nitra
teAn
ti-An
gina
lOt
her t
han
Ultra
Imip
ram
ine
Imip
ram
ine
Depr
essio
nAn
tidep
ress
ant
Othe
r tha
n Ul
traIm
itrex
Sum
atrip
tan
Mig
rain
esVa
scul
ar H
eada
che
Supp
ress
ant
Usua
lly U
ltra
Imod
ium
Lope
ram
ide
Diar
rhea
Antid
iarrh
eal
Usua
lly U
ltra
Impr
ilIm
ipra
min
eDe
pres
sion
Antid
epre
ssan
tOt
her t
han
Ultra
Imur
anAz
atho
prin
eAr
thrit
is, C
rohn
’sIm
mun
osup
pres
sant
Not I
nsur
able
Inda
pam
ide
Inda
pam
ide
Card
iac,
Edem
aAn
tihyp
erte
nsive
, Diu
retic
Othe
r tha
n Ul
traIn
dera
lPr
opan
olol
Card
iac-
Beta
Blo
cker
, Mig
rain
esAn
tihyp
erte
nsive
, Vas
cula
r Hea
dach
esUs
ually
Ultr
a
FOR
PROD
UCER
USE
ON
LY. N
OT F
OR U
SE W
ITH
THE
PUBL
IC.
63
Drug
-Gen
eric
Ge
neric
Nam
eDe
scrip
tion/
Ther
apeu
tic C
lass
Prob
able
Act
ion
& T
rade
Nam
esCo
nditi
ons
Trea
ted
Inde
ride
Com
boCa
rdia
cAn
tihyp
erte
nsive
Usua
lly U
ltra
Indo
cinIn
dom
etha
cinAr
thrit
is, P
ain
NSAI
D, A
ntirh
eum
atic
Othe
r tha
n Ul
traIn
fum
orph
Mor
phin
eNa
rcot
ic Pa
in M
edica
tion
Opio
id A
nalg
esic
Not I
nsur
able
Insu
lin, H
umul
in 5
0/50
NPH/
Regu
lar I
nsul
in M
ixtur
esDi
abet
es, I
nsul
in-D
epen
dent
(IDD
M)
Antid
iabe
ticNo
t Ins
urab
leIn
sulin
, Hum
ulin
70/
30NP
H/Re
gula
r Ins
ulin
Mixt
ures
Diab
etes
, Ins
ulin
-Dep
ende
nt (I
DDM
)An
tidia
betic
Not I
nsur
able
Insu
lin, H
umul
in L
Lent
e In
sulin
Diab
etes
, Ins
ulin
-Dep
ende
nt (I
DDM
)An
tidia
betic
Not I
nsur
able
Insu
lin, H
umul
in N
NPH
Insu
linDi
abet
es, I
nsul
in-D
epen
dent
(IDD
M)
Antid
iabe
ticNo
t Ins
urab
leIn
sulin
, Hum
ulin
U U
ltral
ente
Insu
lin, E
xten
ded
Diab
etes
, Ins
ulin
-Dep
ende
nt (I
DDM
)An
tidia
betic
Not I
nsur
able
Insu
lin, H
umul
in-R
Regu
lar I
nsul
inDi
abet
es, I
nsul
in-D
epen
dent
(IDD
M)
Antid
iabe
ticNo
t Ins
urab
leIn
sulin
, Ile
tin II
RRe
gula
r Ins
ulin
Diab
etes
, Ins
ulin
-Dep
ende
nt (I
DDM
)An
tidia
betic
Not I
nsur
able
Insu
lin, L
ente
Ilet
in II
Lent
e In
sulin
Diab
etes
, Ins
ulin
-Dep
ende
nt (I
DDM
)An
tidia
betic
Not I
nsur
able
Insu
lin, N
ovol
in 7
0/30
NPH/
Regu
lar I
nsul
in M
ixtur
esDi
abet
es, I
nsul
in-D
epen
dent
(IDD
M)
Antid
iabe
ticNo
t Ins
urab
leIn
sulin
, Nov
olin
LLe
nte
Insu
linDi
abet
es, I
nsul
in-D
epen
dent
(IDD
M)
Antid
iabe
ticNo
t Ins
urab
leIn
sulin
, Nov
olin
NNP
H In
sulin
Diab
etes
, Ins
ulin
-Dep
ende
nt (I
DDM
)An
tidia
betic
Not I
nsur
able
Insu
lin, N
ovol
in R
Regu
lar I
nsul
inDi
abet
es, I
nsul
in-D
epen
dent
(IDD
M)
Antid
iabe
ticNo
t Ins
urab
leIn
sulin
, Nov
olin
UIn
sulin
, Ext
ende
dDi
abet
es, I
nsul
in-D
epen
dent
(IDD
M)
Antid
iabe
ticNo
t Ins
urab
leIn
sulin
, NPH
Ilet
in II
NPH
Insu
linDi
abet
es, I
nsul
in-D
epen
dent
(IDD
M)
Antid
iabe
ticNo
t Ins
urab
leIn
sulin
, Ultr
alen
te U
Insu
lin, E
xten
ded
Diab
etes
, Ins
ulin
-Dep
ende
nt (I
DDM
)An
tidia
betic
Not I
nsur
able
Insu
lin, V
elos
ulin
BR
Regu
lar I
nsul
inDi
abet
es, I
nsul
in-D
epen
dent
(IDD
M)
Antid
iabe
ticNo
t Ins
urab
leIn
sulin
; Hum
alog
Insu
lin L
ispro
Diab
etes
, Ins
ulin
-Dep
ende
nt (I
DDM
)An
tidia
betic
Not I
nsur
able
Insu
lin; H
umal
og 5
0/50
Insu
lin L
ispro
/Pro
tam
ine
Mixt
ure
Diab
etes
, Ins
ulin
-Dep
ende
nt (I
DDM
)An
tidia
betic
Not I
nsur
able
Insu
lin; H
umal
og 7
5/25
Insu
lin L
ispro
/Pro
tam
ine
Mixt
ure
Diab
etes
, Ins
ulin
-Dep
ende
nt (I
DDM
)An
tidia
betic
Not I
nsur
able
Insu
lin; N
ovol
ogIn
sulin
Asp
art
Diab
etes
, Ins
ulin
-Dep
ende
nt (I
DDM
)An
tidia
betic
Not I
nsur
able
Insu
lin; L
antu
sIn
sulin
Gla
rgin
eDi
abet
es, I
nsul
in-D
epen
dent
(IDD
M)
Antid
iabe
ticNo
t Ins
urab
leIn
tal
Crom
olyn
Resp
irato
ry In
hale
r/Neb
ulize
rAl
lerg
y, An
tiast
hmat
icUs
ually
Ultr
aIn
terfe
ron
Canc
er/ M
ultip
le S
clero
sisAn
tineo
plas
ticNo
t Ins
urab
leIn
viras
eHI
VAn
tere
trovir
alNo
t Ins
urab
leIrb
esar
tan
Irbes
arta
nHy
perte
nsio
nAn
tihyp
erte
nsive
Usua
lly U
ltra
FOR
PROD
UCER
USE
ON
LY. N
OT F
OR U
SE W
ITH
THE
PUBL
IC.
64
Drug
-Gen
eric
Ge
neric
Nam
eDe
scrip
tion/
Ther
apeu
tic C
lass
Prob
able
Act
ion
& T
rade
Nam
esCo
nditi
ons
Trea
ted
Iso-B
idIso
sorb
ide
Dini
trate
Card
iac-
Nitra
teAn
ti-An
gina
lOt
her t
han
Ultra
Isona
teIso
sorb
ide
Dini
trate
Card
iac-
Nitra
teAn
ti-An
gina
lOt
her t
han
Ultra
Isorb
idIso
sorb
ide
Dini
trate
Card
iac-
Nitra
teAn
ti-An
gina
lOt
her t
han
Ultra
Isord
ilIso
sorb
ide
Dini
trate
Card
iac-
Nitra
teAn
ti-An
gina
lOt
her t
han
Ultra
Isoso
rbid
e Di
nitra
teIso
sorb
ide
Dini
trate
Card
iac-
Nitra
teAn
ti-An
gina
lOt
her t
han
Ultra
Isotra
te E
RIso
sorb
ide
Mon
onitr
ate
Card
iac-
Nitra
teAn
ti-An
gina
lOt
her t
han
Ultra
JJa
nuvia
Diab
etes
Anti
diab
etic
Othe
r tha
n Ul
traIsr
adip
ine
Israd
ipin
eCa
rdia
c-Ca
lcium
Cha
nnel
Blo
cker
Antia
ngin
al, A
ntih
yper
tens
iveOt
her t
han
Ultra
KKa
bolin
-Inje
ctab
leNa
ndro
lone
Dec
anoa
teAn
emia
of R
enal
Fai
lure
Anti-
anem
icNo
t Ins
urab
leKa
dian
Mor
phin
eNa
rcot
ic Pa
in M
edica
tion
Opio
id A
nalg
esic
Not I
nsur
able
K-Du
rPo
tass
ium
Sup
plem
ent
Pota
ssiu
m S
uppl
emen
tPo
tass
ium
Rep
lace
men
tUs
ually
Ultr
aKa
letra
HIV
Ante
retro
viral
Not I
nsur
able
Kem
adrin
Park
inso
n’s D
iseas
eAn
ti Pa
rkin
son
Not I
nsur
able
Kena
cort
Tria
mcin
olon
eSt
eroi
dAn
tiast
hmat
ic, C
ortic
oste
roid
Othe
r tha
n Ul
traKe
rlone
Beta
xolo
lCa
rdia
c- B
eta
Bloc
ker
Antih
yper
tens
iveUs
ually
Ultr
aKe
topr
ofen
Keto
prof
enAr
thrit
is, P
ain
NSAI
DOt
her t
han
Ultra
Klon
opin
Clon
azep
amSe
izure
Diso
rder
Antic
onvu
lsant
Othe
r tha
n Ul
traK-
Lor
Pota
ssiu
m S
uppl
emen
tPo
tass
ium
Sup
plem
ent
Pota
ssiu
m R
epla
cem
ent
Usua
lly U
ltra
Klor
-Con
Pota
ssiu
m S
uppl
emen
tPo
tass
ium
Sup
plem
ent
Pota
ssiu
m R
epla
cem
ent
Usua
lly U
ltra
Klor
vess
Pota
ssiu
m S
uppl
emen
tPo
tass
ium
Sup
plem
ent
Pota
ssiu
m R
epla
cem
ent
Usua
lly U
ltra
FOR
PROD
UCER
USE
ON
LY. N
OT F
OR U
SE W
ITH
THE
PUBL
IC.
65
Drug
-Gen
eric
Ge
neric
Nam
eDe
scrip
tion/
Ther
apeu
tic C
lass
Prob
able
Act
ion
& T
rade
Nam
esCo
nditi
ons
Trea
ted
K-No
rmPo
tass
ium
Sup
plem
ent
Pota
ssiu
m S
uppl
emen
tPo
tass
ium
Rep
lace
men
tUs
ually
Ultr
aKr
italo
seLa
ctul
ose
Gast
roin
test
inal
-Con
stip
atio
nLa
xativ
eUs
ually
Ultr
aK-
Tab
Pota
ssiu
m S
uppl
emen
tPo
tass
ium
Sup
plem
ent
Pota
ssiu
m R
epla
cem
ent
Usua
lly U
ltra
LLa
beta
lol
Labe
talo
lCa
rdia
c- B
eta
Bloc
ker
Antia
ngin
al, A
ntih
yper
tens
iveOt
her t
han
Ultra
Lact
ulos
eLa
ctul
ose
Gast
roin
test
inal
-Con
stip
atio
nLa
xativ
eUs
ually
Ultr
aLa
mict
alLa
mot
rigin
eSe
izure
Diso
rder
Antic
onvu
lsant
Othe
r tha
n Ul
traLa
noph
yllin
Theo
phyll
ine
Resp
irato
ryBr
onch
odila
tor
Othe
r tha
n Ul
traLa
noxic
aps
Digo
xinCa
rdia
cAn
thar
rhyt
hmic
Othe
r tha
n Ul
traLa
noxin
Digo
xinCa
rdia
cAn
thar
rhyt
hmic
Othe
r tha
n Ul
traLa
nzac
Depr
essio
nAn
ti Ps
ycho
ticNo
t Ins
urab
leLa
rgac
tilCh
lorp
rom
azin
ePs
ycho
ses
Antip
sych
otics
, Ant
iem
etic
Not I
nsur
able
Laro
dopa
Levo
dopa
Park
inso
n’sAn
tipar
kinso
nNo
t Ins
urab
leLa
sixFu
rose
mid
eEd
ema
Diur
etic
Usua
lly U
ltra
L-Do
paLe
vodo
paPa
rkin
son’s
Antip
arkin
son
Not I
nsur
able
Lesc
olFlu
vast
atin
Hype
rcho
lest
erol
emia
Lipid
-(fat
)-Low
erin
g dr
ugUs
ually
Ultr
aLe
ucov
orin
Canc
erAn
tineo
plas
ticNo
t Ins
urab
leLe
uker
anCh
lora
mbu
cilCa
ncer
Antn
eopl
astic
, Im
mun
osup
pres
sant
Not I
nsur
able
Leva
lbut
erol
Leva
lbut
erol
Resp
irato
ry In
hale
rBr
onch
odila
tor
Othe
r tha
n Ul
traLe
vetir
acet
amLe
vetir
acet
amSe
izure
Diso
rder
Antic
onvu
lsant
Othe
r tha
n Ul
traLe
vodo
paLe
vodo
paPa
rkin
son’s
Antip
arkin
son
Not I
nsur
able
Levo
thro
idLe
voth
yrox
ine
Thyr
oid
Prep
arat
ions
Horm
one
Usua
lly U
ltra
Levo
thyr
oxin
eLe
voth
yrox
ine
Thyr
oid
Prep
arat
ions
Horm
one
Usua
lly U
ltra
Levo
xyl
Levo
thyr
oxin
eTh
yroi
d Pr
epar
atio
nsHo
rmon
eUs
ually
Ultr
aLe
vsin
Hyos
cyam
ine
Urin
ary,
Gast
roin
test
inal
Antis
pasm
odic,
Ant
ichol
iner
gic
Usua
lly U
ltra
Lexa
pro
Depr
essio
n An
tidep
ress
ant
Othe
r tha
n Ul
tra
FOR
PROD
UCER
USE
ON
LY. N
OT F
OR U
SE W
ITH
THE
PUBL
IC.
66
Drug
-Gen
eric
Ge
neric
Nam
eDe
scrip
tion/
Ther
apeu
tic C
lass
Prob
able
Act
ion
& T
rade
Nam
esCo
nditi
ons
Trea
ted
eLex
ivaHI
VNo
t Ins
urab
leLib
rium
Chlo
rdia
zepo
xide
Anxie
ty-B
enzo
diaz
epin
eAn
tianx
iety,
Sed
ative
/Hyp
notic
Usua
lly U
ltra
Limbi
trol
Com
boAn
xiety,
Dep
ress
ion
Skel
etal
Mus
cle R
elax
ant
Othe
r tha
n Ul
traLio
resa
lBa
clofe
nLe
sions
Antis
past
icity
Age
ntNo
t Ins
urab
leLio
trix
Liotri
xTh
yroi
d Pr
epar
atio
nsHo
rmon
eUs
ually
Ultr
aLip
itor
Ator
vast
atin
Hype
rcho
lest
erol
emia
Lipid
-(fat
)-Low
erin
g dr
ugUs
ually
Ultr
aLis
inop
rilLis
inop
rilCa
rdia
cAn
tihyp
erte
nsive
Usua
lly U
ltra
Lispr
oDi
abet
esAn
ti di
abet
icOt
her t
han
Ultra
Lithi
umLit
hium
Man
ic-De
pres
sion
Antim
anic
Not I
nsur
able
LoCH
OLES
TCh
oles
tyra
min
eHy
perc
hole
ster
olem
iaLip
id-(f
at)-L
ower
ing
drug
Usua
lly U
ltra
Lodi
neEt
odol
acAr
thrit
is, P
ain
Antir
heum
atic,
Non
opio
d An
alge
sicOt
her t
han
Ultra
Lom
otil
Diph
enox
ylate
/Atro
pine
Diar
rhea
Antid
iarrh
eal
Usua
lly U
ltra
Loni
ten
Min
oxid
ilCa
rdia
cAn
tihyp
erte
nsive
Usua
lly U
ltra
Lono
xDi
phen
oxyla
te/A
tropi
neDi
arrh
eaAn
tidia
rrhea
lUs
ually
Ultr
aLo
pera
mid
eLo
pera
mid
eDi
arrh
eaAn
tidia
rrhea
lUs
ually
Ultr
aLo
pid
Gem
fibro
zilHy
perc
hole
ster
olem
iaLip
id-(f
at)-L
ower
ing
drug
Usua
lly U
ltra
Lopr
esso
rM
etop
rolo
lCa
rdia
cAn
tiang
inal
, Ant
ihyp
erte
nsive
Usua
lly U
ltra
Lopu
rinAl
lopu
rinol
Gout
Antig
out A
gent
Usua
lly U
ltra
Lora
zepa
mLo
raze
pam
Anxie
tyAn
tianx
iety,
Sed
ative
/Hyp
notic
Othe
r tha
n Ul
traLo
rcet
Hydr
ocod
one/
Acet
amin
ophe
nNa
rcot
ic Pa
in M
edica
tion
Opio
id A
nalg
esic
Not I
nsur
able
Lorta
bNa
rcot
icAn
alge
sicCa
llLo
sarta
nLo
sarta
nHy
perte
nsio
nAn
tihyp
erte
nsive
Usua
lly U
ltra
Lote
nsin
Bena
zepr
ilCa
rdia
cAn
tihyp
erte
nsive
Usua
lly U
ltra
Lotre
lBe
naze
pril/
Amlo
dipi
ne C
ombo
Card
iac
Antih
yper
tens
iveUs
ually
Ultr
aLo
vast
atin
Lova
stat
inHy
perc
hole
ster
olem
iaLip
id-(f
at)-L
ower
ing
drug
Usua
lly U
ltra
Lozo
lIn
dapa
mid
eCa
rdia
c, Ed
ema
Antih
yper
tens
ive, D
iure
ticUs
ually
Ultr
al
FOR
PROD
UCER
USE
ON
LY. N
OT F
OR U
SE W
ITH
THE
PUBL
IC.
67
Drug
-Gen
eric
Ge
neric
Nam
eDe
scrip
tion/
Ther
apeu
tic C
lass
Prob
able
Act
ion
& T
rade
Nam
esCo
nditi
ons
Trea
ted
Lupr
onCa
ncer
Antin
eopl
astic
Not I
nsur
able
Luvo
xFlu
voxa
min
eDe
pres
sion
Antid
epre
ssan
tOt
her t
han
Ultra
Lyric
aEp
ileps
yAn
ti se
izure
/ner
ve p
ain
Othe
r tha
n Ul
tra
MM
arth
ritic
Salsa
late
Arth
ritis,
Pai
nNS
AID
Othe
r tha
n Ul
traM
axai
r Inh
aler
Pirb
uter
olRe
spira
tory
Inha
ler
Bron
chod
ilato
rOt
her t
han
Ultra
Max
alt
Riza
tript
anM
igra
ines
Vasc
ular
Hea
dach
e Su
ppre
ssan
tUs
ually
Ultr
aM
ecliz
ine
Mec
lizin
eM
otio
n Si
ckne
ss, V
ertig
oAn
tiem
etics
, Ant
ihist
amin
esOt
her t
han
Ultra
Med
rol
Met
hylp
redn
isolo
neSt
eroi
dAn
tiast
hmat
ic, C
ortic
oste
roid
Othe
r tha
n Ul
traM
edro
xypr
oges
tero
neM
edro
xypr
oges
tero
neHo
rmon
e Re
plac
emen
tHo
rmon
eUs
ually
Ultr
aM
egac
eCa
ncer
Antin
eopl
astic
Not I
nsur
able
Meg
estro
lCa
ncer
Antin
eopl
astic
Not I
nsur
able
Mel
laril
Thio
ridaz
ine
Schi
zoph
reni
aAn
tipsy
chot
icNo
t Ins
urab
leM
elph
alan
Canc
erAn
tineo
plas
ticNo
t Ins
urab
leM
eper
idin
eM
eper
idin
eNa
rcot
ic Pa
in M
edica
tion
Opio
id A
nalg
esic
Not I
nsur
able
Mes
tinon
Mya
sthe
nia
Grav
isNo
t Ins
urab
leM
etfo
rmin
Met
form
in(N
IDDM
)An
tidia
betic
Othe
r tha
n Ul
traM
etha
done
Met
hado
neNa
rcot
ic Pa
in M
edica
tion
Opio
id A
nalg
esic
Not I
nsur
able
Met
hoca
rbam
olM
etho
carb
amol
Mus
cle S
pasm
sSk
elet
al M
uscle
Rel
axan
tOt
her t
han
Ultra
Met
hotre
xate
Met
hotre
xate
Rheu
mat
oid
Arth
ritis
DMAR
D, Im
mun
osup
pres
sant
Othe
r tha
n Ul
traM
ethy
ldop
aM
ethy
ldop
aCa
rdia
cAn
tihyp
erte
nsive
Usua
lly U
ltra
Mev
acor
Lova
stat
inHy
perc
hole
ster
olem
iaLip
id-(f
at)-L
ower
ing
drug
Usua
lly U
ltra
Mia
calci
n In
ject
ion
Calci
toni
nOs
teop
oros
is, P
aget
’sHy
poca
lcem
icOt
her t
han
Ultra
Mica
rdis
Telm
isarta
nHy
perte
nsio
nAn
tihyp
erte
nsive
Usua
lly U
ltra
Micr
o-K
Pota
ssiu
m S
uppl
emen
tPo
tass
ium
Sup
plem
ent
Pota
ssiu
m R
epla
cem
ent
Usua
lly U
ltra
Micr
onas
eGl
ybur
ide
(NID
DM)
Antid
iabe
ticOt
her t
han
Ultra
FOR
PROD
UCER
USE
ON
LY. N
OT F
OR U
SE W
ITH
THE
PUBL
IC.
68
Drug
-Gen
eric
Ge
neric
Nam
eDe
scrip
tion/
Ther
apeu
tic C
lass
Prob
able
Act
ion
& T
rade
Nam
esCo
nditi
ons
Trea
ted
Mig
litol
Mig
litol
(NID
DM)
Antid
iabe
ticOt
her t
han
Ultra
Mig
rana
lDi
hydr
oerg
otam
ine
Mig
rain
esVa
scul
ar H
eada
che
Supp
ress
ant
Usua
lly U
ltra
Milo
ntin
Epile
psy
Antic
onvu
lsant
Othe
r tha
n Ul
traM
inip
ress
Praz
osin
Card
iac,
Pros
tate
Enl
arge
men
tAn
tihyp
erte
nsive
, BPH
Usua
lly U
ltra
Min
itran
Nito
glyc
erin
Card
iac-
Nitra
teAn
ti-An
gina
lOt
her t
han
Ultra
Min
oxid
ilM
inox
idil
Card
iac
Antih
yper
tens
iveUs
ually
Ultr
aM
irape
xPr
amip
exol
ePa
rkin
sons
Antip
arkin
son
Not I
nsur
able
Mob
icAr
thrit
isNS
AID
Othe
r tha
n Ul
traM
olin
done
Depr
essio
nAn
tipsy
chot
icNo
t Ins
urab
leM
onok
etIso
sorb
ide
Mon
onitr
ate
Card
iac-
Nitra
teAn
ti-An
gina
lOt
her t
han
Ultra
Mon
opril
Fosin
opril
Card
iac
Antih
yper
tens
iveUs
ually
Ultr
aM
orph
ine
Mor
phin
eNa
rcot
ic Pa
in M
edica
tion
Opio
id A
nalg
esic
Not I
nsur
able
Mot
ofen
Defe
noxin
/Atro
pine
Diar
rhea
Antid
iarrh
eal
Usua
lly U
ltra
Mot
rinIb
upro
fen
Arth
ritis,
Pai
nNS
AID
Usua
lly U
ltra
MS
Cont
inM
orph
ine
Narc
otic
Pain
Med
icatio
nOp
ioid
Ana
lges
icNo
t Ins
urab
leM
utam
ycin
Canc
erNo
t Ins
urab
leM
ylera
nCa
ncer
Not I
nsur
able
Myo
trol
Orph
enad
rine
Mus
cle S
pasm
sSk
elet
al M
uscle
Rel
axan
tOt
her t
han
Ultra
Mys
olin
ePr
imad
one
Seizu
re D
isord
erOt
her t
han
Ultra
NNa
bum
eton
eNa
bum
eton
eAr
thrit
is, P
ain
NSAI
D, A
ntirh
eum
atic
Othe
r tha
n Ul
traNa
lfon
Arth
ritis
Anti
arth
ritic
Othe
r tha
n Ul
traNa
ltrex
one
Alco
holis
mAn
tirhe
umat
icNo
t Ins
urab
leNa
men
daAl
zhei
mer
’sAn
ti de
men
tiaNo
t Ins
urab
leNa
ndro
lone
Dec
anoa
teNa
ndro
lone
Dec
anoa
teAn
emia
of R
enal
Fai
lure
Anti-
anem
icNo
t Ins
urab
leNa
prox
enNa
prox
enAr
thrit
is, P
ain
NSAI
DOt
her t
han
Ultra
FOR
PROD
UCER
USE
ON
LY. N
OT F
OR U
SE W
ITH
THE
PUBL
IC.
69
Drug
-Gen
eric
Ge
neric
Nam
eDe
scrip
tion/
Ther
apeu
tic C
lass
Prob
able
Act
ion
& T
rade
Nam
esCo
nditi
ons
Trea
ted
Nara
tript
anNa
ratri
ptan
Mig
rain
esVa
scul
ar H
eada
che
Supp
ress
ant
Usua
lly U
ltra
Nard
ilPh
enel
zine
Depr
essio
nAn
tidep
ress
ant-M
AO In
ibito
rsOt
her t
han
Ultra
Nate
glin
ide
Nate
glin
ide
(NID
DM)
Antid
iabe
ticOt
her t
han
Ultra
Nava
neDe
pres
sion
Antip
sych
otic
Not I
nsur
able
Nave
lbin
eCa
ncer
Canc
erNo
t Ins
urab
leNe
docr
omil
Nedo
crom
ilRe
spira
tory
Antia
sthm
atic,
Alle
rgie
sUs
ually
Ultr
aNe
fazo
done
Nefa
zodo
neDe
pres
sion
Antid
epre
ssan
tOt
her t
han
Ultra
Neor
alCy
closp
orin
eAr
thrit
is, U
lcera
tive
Colit
isIm
mun
osup
pres
sant
Not I
nsur
able
Neos
arCy
cloph
osph
amid
eCa
ncer
, Rhe
umat
oid
Arth
ritis
Imm
unos
uppr
essa
ntNo
t Ins
urab
leNe
upog
enCa
ncer
Not I
nsur
able
Neur
ontin
Gaba
pent
inM
igra
ines
Antic
onvu
lsant
, Ana
lges
ic Ad
junc
tOt
her t
han
Ultra
Nexiu
mEs
omep
razo
leGa
stro
inte
stin
alAn
iulce
r Age
ntUs
ually
Ultr
aNi
a-Bi
dNi
acin
Hype
rcho
lest
erol
emia
, Sup
plem
ent
Lipid
-(fat
)-Low
erin
g dr
ug, V
itam
inUs
ually
Ultr
aNi
acNi
acin
Hype
rcho
lest
erol
emia
, Sup
plem
ent
Lipid
-(fat
)-Low
erin
g dr
ug, V
itam
inUs
ually
Ultr
aNi
acin
Niac
inHy
perc
hole
ster
olem
ia, S
uppl
emen
tLip
id-(f
at)-L
ower
ing
drug
, Vita
min
Usua
lly U
ltra
Niac
orNi
acin
Hype
rcho
lest
erol
emia
, Sup
plem
ent
Lipid
-(fat
)-Low
erin
g dr
ug, V
itam
inUs
ually
Ultr
aNi
aspa
nNi
acin
Hype
rcho
lest
erol
emia
, Sup
plem
ent
Lipid
-(fat
)-Low
erin
g dr
ug, V
itam
inUs
ually
Ultr
aNi
cobi
dNi
acin
Hype
rcho
lest
erol
emia
, Sup
plem
ent
Lipid
-(fat
)-Low
erin
g dr
ug, V
itam
inUs
ually
Ultr
aNi
cola
rNi
acin
Hype
rcho
lest
erol
emia
, Sup
plem
ent
Lipid
-(fat
)-Low
erin
g dr
ug, V
itam
inUs
ually
Ultr
aNi
cotin
exNi
acin
Hype
rcho
lest
erol
emia
, Sup
plem
ent
Lipid
-(fat
)-Low
erin
g dr
ug, V
itam
inUs
ually
Ultr
aNi
cotin
ic Ac
idNi
acin
Hype
rcho
lest
erol
emia
, Sup
plem
ent
Lipid
-(fat
)-Low
erin
g dr
ug, V
itam
inUs
ually
Ultr
aNi
togl
ycer
inNi
togl
ycer
inCa
rdia
c-Ni
trate
Anti-
Angi
nal
Othe
r tha
n Ul
traNi
trek
Nito
glyc
erin
Card
iac-
Nitra
teAn
ti-An
gina
lOt
her t
han
Ultra
Nitro
-Bid
Nito
glyc
erin
Card
iac-
Nitra
teAn
ti-An
gina
lOt
her t
han
Ultra
Nitro
cot
Nito
glyc
erin
Card
iac-
Nitra
teAn
ti-An
gina
lOt
her t
han
Ultra
Nitro
-Dur
Nito
glyc
erin
Card
iac-
Nitra
teAn
ti-An
gina
lOt
her t
han
Ultra
Nitro
glyn
E-R
Nito
glyc
erin
Card
iac-
Nitra
teAn
ti-An
gina
lOt
her t
han
Ultra
Nitro
lNi
togl
ycer
inCa
rdia
c-Ni
trate
Anti-
Angi
nal
Othe
r tha
n Ul
tra
FOR
PROD
UCER
USE
ON
LY. N
OT F
OR U
SE W
ITH
THE
PUBL
IC.
70
Drug
-Gen
eric
Ge
neric
Nam
eDe
scrip
tion/
Ther
apeu
tic C
lass
Prob
able
Act
ion
& T
rade
Nam
esCo
nditi
ons
Trea
ted
Nitro
-par
Nito
glyc
erin
Card
iac-
Nitra
teAn
ti-An
gina
lOt
her t
han
Ultra
Nitro
pres
sNi
tropr
ussid
eCa
rdia
cAn
tihyp
erte
nsive
Usua
lly U
ltra
Nitro
prus
side
Nitro
prus
side
Card
iac
Antih
yper
tens
iveUs
ually
Ultr
aNi
trost
atNi
togl
ycer
inCa
rdia
c-Ni
trate
Anti-
Angi
nal
Othe
r tha
n Ul
traNi
tro-T
ime
Nito
glyc
erin
Card
iac-
Nitra
teAn
ti-An
gina
lOt
her t
han
Ultra
Niza
tidin
eNi
zatid
ine
Gast
roin
test
inal
Antiu
lcer A
gent
Usua
lly U
ltra
Nizo
ral
Antif
unga
lUs
ually
Ultr
aNo
lvade
xBr
east
Can
cer
Othe
r tha
n Ul
traNo
rflex
Orph
enad
rine
Mus
cle S
pasm
sSk
elet
al M
uscle
Rel
axan
tOt
her t
han
Ultra
Norfr
anil
Imip
ram
ine
Depr
essio
nAn
tidep
ress
ant
Othe
r tha
n Ul
traNo
rpac
eDi
sopy
ram
ide
Card
iac
Antia
rrhyt
hmic
Othe
r tha
n Ul
traNo
rpra
min
Desip
ram
ine
Depr
essio
nAn
tidep
ress
ant
Othe
r tha
n Ul
traNo
rtrip
tylin
eDe
pres
sion
Othe
r tha
n Ul
traNo
rvas
cAm
lodi
pine
Card
iac-
Calci
um C
hann
el B
lock
erAn
tihyp
erte
nsive
Usua
lly U
ltra
Novo
-Flu
rpro
fen
Flurb
ipro
fen
Arth
ritis
NSAI
D, A
ntirh
eum
atic
Othe
r tha
n Ul
traNo
voHy
draz
ide
Hydr
ochl
orot
hiaz
ide
Card
iac,
Edem
aAn
tihyp
erte
nsive
, Diu
retic
Usua
lly U
ltra
NPH
Insu
linNP
H In
sulin
Diab
etes
, Ins
ulin
-Dep
ende
nt (I
DDM
)An
tidia
betic
Othe
r tha
n Ul
traNu
bain
Nalb
uphi
neNa
rcot
ic Pa
in M
edica
tion
Opio
id A
nalg
esic
Not I
nsur
able
Nu-D
iltia
zDi
ltiaz
emCa
rdia
c-Ca
lcium
Cha
nnel
Blo
cker
Antih
perte
nsive
sUs
ually
Ultr
aNu
Lev
Hyos
cyam
ine
Urin
ary,
Gast
roin
test
inal
Antis
pasm
odic,
Ant
ichol
iner
gic
Usua
lly U
ltra
Nupr
inIb
upro
fen
Arth
ritis,
Pai
nNS
AID
Othe
r tha
n Ul
traNu
-Sel
egili
neSe
legi
line
Park
inso
n’sAn
tipar
kinso
nNo
t Ins
urab
le
FOR
PROD
UCER
USE
ON
LY. N
OT F
OR U
SE W
ITH
THE
PUBL
IC.
71
Drug
-Gen
eric
Ge
neric
Nam
eDe
scrip
tion/
Ther
apeu
tic C
lass
Prob
able
Act
ion
& T
rade
Nam
esCo
nditi
ons
Trea
ted
OOc
tam
ide
Met
oclo
pram
ide
Gast
roin
test
inal
Antie
met
icUs
ually
Ultr
aOl
anza
pine
Olan
zapi
neSc
hizo
phre
nia,
Anr
oexia
Ner
vosa
Antip
sych
otic
Not I
nsur
able
Omep
razo
leOm
epra
zole
Gast
roin
test
inal
Aniu
lcer A
gent
Usua
lly U
ltra
Orap
Depr
essio
nAn
tipsy
chot
icNo
t Ins
urab
leOr
etic
Hydr
ochl
orot
hiaz
ide
Card
iac,
Edem
aAn
tihyp
erte
nsive
, Diu
retic
Usua
lly U
ltra
Orfro
Orph
enad
rine
Mus
cle S
pasm
sSk
elet
al M
uscle
Rel
axan
tOt
her t
han
Ultra
Orin
ase
Diab
etes
Anti
diab
etic
Othe
r tha
n Ul
traOr
phen
adrin
eOr
phen
adrin
eM
uscle
Spa
sms
Skel
etal
Mus
cle R
elax
ant
Othe
r tha
n Ul
traOr
phen
ate
Orph
enad
rine
Mus
cle S
pasm
sSk
elet
al M
uscle
Rel
axan
tOt
her t
han
Ultra
Orud
isKe
topr
ofen
Arth
ritis,
Pai
nNS
AID
Othe
r tha
n Ul
traOx
apro
zinOx
apro
zinAr
thrit
is, P
ain
NSAI
D, A
ntirh
eum
atic
Othe
r tha
n Ul
traOx
azep
amOx
azep
amAn
xiety
Antia
nxie
ty, S
edat
ive/H
ypno
ticOt
her t
han
Ultra
Oxca
rbaz
epin
eOx
carb
azep
ine
Seizu
re D
isord
erAn
ticon
vulsa
ntOt
her t
han
Ultra
Oxyb
utyn
inCo
ntin
ence
Othe
r tha
n Ul
traOx
ycod
one
Oxyc
odon
eNa
rcot
ic Pa
in M
edica
tion
Opio
id A
nalg
esic
Not I
nsur
able
Oxyc
ontin
Oxyc
odon
eNa
rcot
ic Pa
in M
edica
tion
Opio
id A
nalg
esic
Not I
nsur
able
PPa
cero
neAm
ioda
rone
Card
iac
Antia
rrhyt
hmics
Othe
r tha
n Ul
traPa
mel
orNo
rtrip
tylin
eDe
pres
sion
Antid
epre
ssan
tOt
her t
han
Ultra
Pam
idro
nate
Pam
idro
nate
Hype
rcal
cem
ia, P
aget
’sBo
ne R
esor
ptio
n In
hibi
tor
Othe
r tha
n Ul
traPa
rafo
n Fo
rteCh
lorzo
xazo
neM
uscle
Spa
sms
Skel
etal
Mus
cle R
elax
ant
Othe
r tha
n Ul
traPa
rlode
lBr
omoc
riptin
eFe
rtilit
yAn
tipar
kinso
nNo
t Ins
urab
lePa
rnat
eTr
anylc
ypro
min
eDe
pres
sion
Antid
epre
ssan
t-MAO
Inib
itors
Othe
r tha
n Ul
traPa
roxe
tine
Paro
xetin
eAn
xiety,
Dep
rssio
nAn
tianx
iety,
Ant
idep
ress
ant
Othe
r tha
n Ul
tra
FOR
PROD
UCER
USE
ON
LY. N
OT F
OR U
SE W
ITH
THE
PUBL
IC.
72
Drug
-Gen
eric
Ge
neric
Nam
eDe
scrip
tion/
Ther
apeu
tic C
lass
Prob
able
Act
ion
& T
rade
Nam
esCo
nditi
ons
Trea
ted
Paxil
Paro
xetin
eAn
xiety,
Dep
rssio
nAn
tianx
iety,
Ant
idep
ress
ant
Othe
r tha
n Ul
traPe
gano
neSe
izure
Diso
rder
Anti
seizu
reOt
her t
han
Ultra
Pem
olin
ePe
mol
ine
Stim
ulan
t, AD
HDCe
ntal
Ner
vous
Sys
tem
Stim
ulan
tUs
ually
Ultr
aPe
ntam
idin
eAI
DSAn
tiret
rovir
alNo
t Ins
urab
lePe
ntas
aM
esal
amin
eGa
stro
inte
stin
al-U
lcera
tive
Colit
isGI
Ant
iinfla
mm
ator
yOt
her t
han
Ultra
Pent
azin
ePr
omet
hazin
eAl
lerg
ies,
Seda
tion,
Nau
sea/
Vom
iting
Seda
tive/
Hypn
otic
Usua
lly U
ltra
Pepc
idTa
mot
idin
eGa
stro
inte
stin
alAn
iulce
r Age
ntUs
ually
Ultr
aPe
rcoc
etOx
ycod
one/
Acet
amin
ophe
nNa
rcot
ic Pa
in M
edica
tion
Opio
id A
nalg
esic
Call
Perc
odan
Oxyc
odon
e/As
pirin
Narc
otic
Pain
Med
icatio
nOp
ioid
Ana
lges
icCa
llPe
rgol
ide
Perg
olid
ePa
rkin
son’s
Antip
arkin
son
Not I
nsur
able
Perin
dopr
ilPe
rindo
pril
Card
iac
Antih
yper
tens
iveUs
ually
Ultr
aPe
ritra
teCa
rdia
cAn
ti an
gina
lOt
her t
han
Ultra
Perm
axPe
rgol
ide
Park
inso
n’sAn
tipar
kinso
nNo
t Ins
urab
lePe
rmiti
lDe
pres
sion
Antip
sych
otic
Not I
nsur
able
Pexe
vaDe
pres
sion
Antip
sych
otic
Not I
nsur
able
Phen
elzin
ePh
enel
zine
Depr
essio
nAn
tidep
ress
ant-M
AO In
ibito
rsOt
her t
han
Ultra
Phen
erga
nPr
omet
hazin
eAl
lerg
ies,
Seda
tion,
Nau
sea/
Vom
iting
Seda
tive/
Hypn
otic
Usua
lly U
ltra
Phen
ytoi
nPh
enyt
oin
Seizu
re D
isord
erAn
tiarry
thm
ic, A
ntico
nvul
sant
Othe
r tha
n Ul
traPh
ylloc
ontin
Amin
ophy
lline
Resp
irato
ryBr
onch
odila
tor
Othe
r tha
n Ul
traPi
loca
rpin
eGl
auco
ma
Usua
lly U
ltra
Pim
ecro
limus
Pim
ecro
limus
Derm
atiti
sTo
pica
l Im
mun
osup
pres
sant
Usua
lly U
ltra
Pind
olol
Visk
enCa
rdia
c- B
eta
Bloc
ker
Antih
yper
tens
iveUs
ually
Ultr
aPi
oglit
azon
ePi
oglit
azon
e(N
IDDM
)An
tidia
betic
Othe
r tha
n Ul
traPi
rbut
erol
Pirb
uter
olRe
spira
tory
Inha
ler
Bron
chod
ilato
rOt
her t
han
Ultra
Plaq
ueni
lHy
drox
ychl
oroq
uine
Rhem
atoi
d Ar
thrit
is, S
LEDM
ARD
Othe
r tha
n Ul
traPl
atin
olCa
ncer
Not I
nsur
able
Plav
ixAn
ticoa
gula
ntOt
her t
han
Ultra
Plen
dil
Felo
dipi
neCa
rdia
c-Ca
lcium
Cha
nnel
Blo
cker
Antia
ngin
al, A
ntih
yper
tens
iveOt
her t
han
Ultra
FOR
PROD
UCER
USE
ON
LY. N
OT F
OR U
SE W
ITH
THE
PUBL
IC.
73
Drug
-Gen
eric
Ge
neric
Nam
eDe
scrip
tion/
Ther
apeu
tic C
lass
Prob
able
Act
ion
& T
rade
Nam
esCo
nditi
ons
Trea
ted
Portl
acLa
ctul
ose
Gast
roin
test
inal
-Con
stip
atio
nLa
xativ
eUs
ually
Ultr
aPr
amip
exol
ePr
amip
exol
ePa
rkin
sons
Antip
arkin
son
Not I
nsur
able
Pran
din
Repa
glin
ide
(NID
DM)
Antid
iabe
ticOt
her t
han
Ultra
Prav
asta
tinPr
avas
tatin
Hype
rcho
lest
erol
emia
Lipid
-(fat
)-Low
erin
g dr
ugUs
ually
Ultr
aPr
azos
inPr
azos
inCa
rdia
c, Pr
osta
te E
nlar
gem
ent
Antih
yper
tens
ive, B
PHUs
ually
Ultr
aPr
ecos
eAc
arbo
se(N
IDDM
)An
tidia
betic
Othe
r tha
n Ul
traPr
edni
sone
Pred
niso
neSt
eroi
dAn
tiast
hmat
ic, C
ortic
oste
roid
Othe
r tha
n Ul
traPr
evac
idLa
nsop
razo
leGa
stro
inte
stin
al- U
lcer D
iseas
eAn
iulce
r Age
ntUs
ually
Ultr
aPr
eval
iteCh
oles
tyra
min
eHy
perc
hole
ster
olem
iaLip
id-(f
at)-L
ower
ing
drug
Usua
lly U
ltra
Prez
ista
HIV
Antir
etro
viral
Not I
nsur
able
Prilo
sec
Omep
razo
leGa
stro
inte
stin
alAn
iulce
r Age
ntUs
ually
Ultr
aPr
inivi
lLis
inop
rilCa
rdia
cAn
tihyp
erte
nsive
Usua
lly U
ltra
Prob
enec
idGo
utUs
ually
Ultr
aPr
ocan
bid
Proc
aina
mid
eCa
rdia
cAn
tiarrh
ythm
icsOt
her t
han
Ultra
Proc
ardi
aNi
fedi
pine
Card
iac-
Calci
um C
hann
el B
lock
erAn
tiang
inal
, Ant
ihpe
rtens
ives
Usua
lly U
ltra
Proc
ritEp
oetin
Anem
ia o
f Chr
onic
Rena
l Fai
lure
Anti-
anem
icNo
t Ins
urab
lePr
ogra
fTa
crol
imus
Dise
ases
Imm
unos
uppr
essa
ntNo
t Ins
urab
lePr
olixi
nFlu
phen
azin
ePs
ycho
ses
Antip
sych
otic
Not I
nsur
able
Pron
esty
lPr
ocai
nam
ide
Card
iac
Antia
rrhyt
hmics
Othe
r tha
n Ul
traPr
ostig
min
Mya
sthe
nia
Grav
isNo
t Ins
urab
lePr
oton
ixPa
ntop
razo
leGa
stro
inte
stin
alAn
iulce
r Age
ntUs
ually
Ultr
aPr
ovac
hol
Prav
asta
tinHy
perc
hole
ster
olem
iaLip
id-(f
at)-L
ower
ing
drug
Usua
lly U
ltra
Prov
entil
Albu
tero
lRe
spira
tory
Bron
chod
ilato
rOt
her t
han
Ultra
Prov
igil
Narc
olep
syOt
her t
han
Ultra
Proz
acFlu
oxet
ine
Depr
essio
nAn
tidep
ress
ant
Othe
r tha
n Ul
traPu
lmico
rtBu
deso
nide
Inha
ler
Resp
irato
ry In
hale
rCo
rtico
rste
roid
Inha
ler,
Antia
sthm
atic
Othe
r tha
n Ul
traPu
rinet
hol /
MP6
Canc
erNo
t Ins
urab
lePy
ridiu
mUr
inar
y-Bl
adde
rAn
ti bl
adde
r spa
smUs
ually
Ultr
a
FOR
PROD
UCER
USE
ON
LY. N
OT F
OR U
SE W
ITH
THE
PUBL
IC.
74
Drug
-Gen
eric
Ge
neric
Nam
eDe
scrip
tion/
Ther
apeu
tic C
lass
Prob
able
Act
ion
& T
rade
Nam
esCo
nditi
ons
Trea
ted
QQu
estra
nCh
oles
tyra
min
eHy
perc
hole
ster
olem
iaLip
id-(f
at)-L
ower
ing
drug
Usua
lly U
ltra
Quet
iapi
neQu
etia
pine
Schi
zoph
reni
aAn
tipsy
chot
icNo
t Ins
urab
leQu
ibro
n-T
Theo
phyll
ine
Resp
irato
ryBr
onch
odila
tor
Othe
r tha
n Ul
traQu
inal
anQu
inid
ine
Gluc
onat
eCa
rdia
cAn
tiarry
thm
icsOt
her t
han
Ultra
Quin
idin
eQu
inid
ine
Sulfa
teCa
rdia
cAn
tiarry
thm
icsOt
her t
han
Ultra
Quin
idin
e Gl
ucon
ate
Quin
idin
e Gl
ucon
ate
Card
iac
Antia
rryth
mics
Othe
r tha
n Ul
traQu
inid
ine
Sulfa
teQu
inid
ine
Sulfa
teCa
rdia
cAn
tiarry
thm
icsOt
her t
han
Ultra
RRa
loxif
ene
Ralo
xifen
eOs
teop
oros
isBo
ne R
esor
ptio
n In
hibi
tors
Othe
r tha
n Ul
traRa
mip
rilRa
mip
rilCa
rdia
cAn
tihyp
erte
nsive
Usua
lly U
ltra
Rane
xaCa
rdia
cAn
tiang
inal
Othe
r tha
n Ul
traRa
nitid
ine
Rani
tidin
eGa
stro
inte
stin
alAn
tiulce
r Age
ntUs
ually
Ultr
aRe
betro
nHe
patit
is C
Hept
itis
agen
tNo
t Ins
urab
leRe
glan
Met
oclo
pram
ide
Gast
roin
test
inal
Antie
met
icUs
ually
Ultr
aRe
gula
r Ins
ulin
Regu
lar I
nsul
inDi
abet
es, I
nsul
in-D
epen
dent
(IDD
M)
Antid
iabe
ticOt
her t
han
Ultra
Rela
fen
Nabu
met
one
Arth
ritis,
Pai
nNS
AID,
Ant
irheu
mat
icOt
her t
han
Ultra
Rela
xazo
neCh
lorzo
xazo
neM
uscle
Spa
sms
Skel
etal
Mus
cle R
elax
ant
Othe
r tha
n Ul
traRe
mer
onM
irtaz
apin
eDe
pres
sion
Antid
epre
ssan
tOt
her t
han
Ultra
Rem
icade
Infli
ximab
Rheu
mat
oid
Arth
ritis,
Cro
hn’s
DMAR
D, G
I Ant
iinfla
mm
ator
yOt
her t
han
Ultra
Rem
inyl
Gala
ntam
ine
Alzh
eim
ers/
Mem
ory
Anti-
Alzh
eirm
erNo
t Ins
urab
leRe
mul
arCh
lorzo
xazo
neM
uscle
Spa
sms
Skel
etal
Mus
cle R
elax
ant
Othe
r tha
n Ul
traRe
pagl
inid
eRe
pagl
inid
e(N
IDDM
)An
tidia
betic
Othe
r tha
n Ul
traRe
quip
Ropi
niro
lePa
rkin
sons
Antip
arkin
son
Not I
nsur
able
Resc
ripto
rDe
lavir
dine
HIV
Infe
ctio
nAn
tiret
rovir
alNo
t Ins
urab
le
FOR
PROD
UCER
USE
ON
LY. N
OT F
OR U
SE W
ITH
THE
PUBL
IC.
75
Drug
-Gen
eric
Ge
neric
Nam
eDe
scrip
tion/
Ther
apeu
tic C
lass
Prob
able
Act
ion
& T
rade
Nam
esCo
nditi
ons
Trea
ted
Rese
rpin
eCa
rdia
cOt
her t
han
Ultra
Resp
bid
Theo
phyll
ine
Resp
irato
ryBr
onch
odila
tor
Othe
r tha
n Ul
traRe
sper
idon
eRe
sper
idon
ePs
ycho
tic D
isord
ers
Antip
sych
otic
Not I
nsur
able
Rest
oril
Slee
ping
Pill
Usua
lly U
ltra
Retro
virAz
idot
hym
idin
eHI
V In
fect
ion
Antir
etro
viral
Not I
nsur
able
Rezu
linDi
abet
esOt
her t
han
Ultra
Rheu
mat
rex
Met
hotre
xate
Rheu
mat
oid
Arth
ritis
DMAR
D, Im
mun
osup
pres
sant
Othe
r tha
n Ul
traRi
daur
a (G
old)
Arth
ritis
Not I
nsur
able
Risp
erda
lRi
sper
idon
ePs
ycho
tic D
isord
ers
Antip
sych
otic
Not I
nsur
able
Risp
erid
one
Risp
erid
one
Psyc
hotic
Diso
rder
sAn
tipsy
chot
icNo
t Ins
urab
leRi
talin
Stim
ulan
tUs
ually
Ultr
aRi
tuxin
Canc
erNo
t Ins
urab
leRi
vast
igm
ine
Riva
stig
min
eAl
zhei
mer
s/M
emor
yAn
ti-Al
zhei
rmer
Not I
nsur
able
Riza
tript
anRi
zatri
ptan
Mig
rain
esVa
scul
ar H
eada
che
Supp
ress
ant
Usua
lly U
ltra
Roba
xinM
etho
carb
amol
Mus
cle S
pasm
sSk
elet
al M
uscle
Rel
axan
tOt
her t
han
Ultra
Rofe
coxib
Rofe
coxib
Arth
ritis
NSAI
DOt
her t
han
Ultra
Rofe
ron
Canc
erNo
t Ins
urab
leRo
pini
role
Ropi
niro
lePa
rkin
sons
Antip
arkin
son
Not I
nsur
able
Rosig
litaz
one
Rosig
litaz
one
(NID
DM)
Antid
iabe
ticOt
her t
han
Ultra
Row
asa
Mes
alam
ine
Gast
roin
test
inal
-Ulce
rativ
e Co
litis
GI A
ntiin
flam
mat
ory
Usua
lly U
ltra
Roxa
nol
Mor
phin
eNa
rcot
ic Pa
in M
edica
tion
Opio
id A
nalg
esic
Not I
nsur
able
Roxic
etOx
ycod
one/
Acet
amin
ophe
nNa
rcot
ic Pa
in M
edica
tion
Opio
id A
nalg
esic
Not I
nsur
able
Roxic
odon
eOx
ycod
one
Narc
otic
Pain
Med
icatio
nOp
ioid
Ana
lges
icNo
t Ins
urab
leRo
xiprin
Oxyc
odon
e/As
pirin
Narc
otic
Pain
Med
icatio
nOp
ioid
Ana
lges
icNo
t Ins
urab
leRu
bex
Doxo
rubi
cin H
ydro
chlo
ride
Canc
erAn
tineo
plas
ticNo
t Ins
urab
leRy
thm
odan
Diso
pyra
mid
eCa
rdia
cAn
tiarrh
ythm
icOt
her t
han
Ultra
Ryth
mol
Prop
afen
one
Card
iac
Antia
rrhyt
hmic
Othe
r tha
n Ul
tra
FOR
PROD
UCER
USE
ON
LY. N
OT F
OR U
SE W
ITH
THE
PUBL
IC.
76
Drug
-Gen
eric
Ge
neric
Nam
eDe
scrip
tion/
Ther
apeu
tic C
lass
Prob
able
Act
ion
& T
rade
Nam
esCo
nditi
ons
Trea
ted
SSa
lbut
amol
Albu
tero
lRe
spira
tory
Bron
chod
ilato
rOt
her t
han
Ultra
Salfl
exSa
lsala
teAr
thrit
is, P
ain
NSAI
DOt
her t
han
Ultra
Salg
esic
Salsa
late
Arth
ritis,
Pai
nNS
AID
Othe
r tha
n Ul
traSa
lmet
erol
Salm
eter
olRe
spira
tory
Inha
ler
Bron
chod
ilato
rOt
her t
han
Ultra
Sand
imm
une
Cyclo
spor
ine
Arth
ritis,
Ulce
rativ
e Co
litis
Imm
unos
uppr
essa
ntNo
t Ins
urab
leSa
quin
avir
HIV
Antir
etro
viral
Not I
nsur
able
Sara
fem
Fluox
etin
eDe
pres
sion
Antid
epre
ssan
tOt
her t
han
Ultra
Scop
alam
ine
Scop
alam
ine
Mot
ion
Sick
ness
(Tra
nsde
rmal
)An
item
etic
Usua
lly U
ltra
SD-D
epre
nyl
Sele
gilin
ePa
rkin
son’s
Antip
arkin
son
Not I
nsur
able
Sect
ral
Aceb
utol
olCa
rdia
c-Be
ta B
lock
erAn
tiarrh
ythm
ic, A
ntih
yper
tens
iveOt
her t
han
Ultra
Sele
gilin
eSe
legi
line
Park
inso
n’sAn
tipar
kinso
nNo
t Ins
urab
leSe
rax
Oxaz
epam
Anxie
tyAn
tianx
iety,
Sed
ative
/Hyp
notic
Othe
r tha
n Ul
traSe
reve
ntSa
lmet
erol
Resp
irato
ry In
hale
rBr
onch
odila
tor
Othe
r tha
n Ul
traSe
rlect
Depr
essio
nAn
tipsy
chot
icNo
t Ins
urab
leSe
roqu
elQu
etia
pine
Schi
zoph
reni
aAn
tipsy
chot
icNo
t Ins
urab
leSe
rtral
ine
Sertr
alin
eDe
pres
sion
Antid
epre
ssan
tOt
her t
han
Ultra
Serzo
neNe
fazo
done
Depr
essio
nAn
tidep
ress
ant
Othe
r tha
n Ul
traSi
mva
stat
inSi
mva
stat
inHy
perc
hole
ster
olem
iaLip
id-(f
at)-L
ower
ing
drug
Usua
lly U
ltra
Sine
met
Carb
idop
a/Le
vodo
paPa
rkin
son’s
, Use
d fo
r Res
tless
Leg
Antip
arkin
son
Not I
nsur
able
Sine
quan
Doxe
pin
Depr
essio
nAn
tianx
iety,
Ant
idep
ress
ant
Othe
r tha
n Ul
traSi
ngul
air
Mon
telu
kast
Resp
irato
ryBr
onch
odila
tor
Othe
r tha
n Ul
traSk
elax
inM
etax
alon
eM
uscle
Spa
sms
Skel
etal
Mus
cle R
elax
ant
Othe
r tha
n Ul
traSl
o-Ni
acin
Niac
inHy
perc
hole
ster
olem
ia, S
uppl
emen
tLip
id-(f
at)-L
ower
ing
drug
, Vita
min
Usua
lly U
ltra
Sola
raze
Declo
fena
cAr
thrit
isNS
AID
Othe
r tha
n Ul
traSo
lazin
eTr
ifluo
pera
zine
Antip
sych
otics
Antip
sych
otics
Not I
nsur
able
FOR
PROD
UCER
USE
ON
LY. N
OT F
OR U
SE W
ITH
THE
PUBL
IC.
77
Drug
-Gen
eric
Ge
neric
Nam
eDe
scrip
tion/
Ther
apeu
tic C
lass
Prob
able
Act
ion
& T
rade
Nam
esCo
nditi
ons
Trea
ted
Som
aCa
risop
rodo
lM
uscle
Spa
sms
Skel
etal
Mus
cle R
elax
ant
Othe
r tha
n Ul
traSo
rbitr
ate
Isoso
rbid
e Di
nitra
teCa
rdia
c-Ni
trate
Anti-
Angi
nal
Othe
r tha
n Ul
traSo
talo
lSo
talo
lCa
rdia
c-Be
ta B
lock
erAn
tiarrh
ythm
icOt
her t
han
Ultra
Spar
ine
Depr
essio
nAn
tipsy
chot
icNo
t Ins
urab
leSt
arlix
Nate
glin
ide
(NID
DM)
Antid
iabe
ticOt
her t
han
Ultra
Stel
azin
eTr
ifluo
pera
zine
Antip
sych
otics
Antip
sych
otics
Not I
nsur
able
Stra
ttera
Atte
ntio
n De
ficit
Diso
rder
Usua
lly U
ltra
Sulin
dac
Sulin
dac
Arth
ritis,
Pai
nNS
AID,
Ant
irheu
mat
icOt
her t
han
Ultra
Sum
atrip
tan
Sum
atrip
tan
Mig
rain
esVa
scul
ar H
eada
che
Supp
ress
ant
Usua
lly U
ltra
Sust
aire
Theo
phyll
ine
Resp
irato
ryBr
onch
odila
tor
Othe
r tha
n Ul
traSy
mm
etre
lAm
anta
dine
Park
inso
n’s, V
iral I
nfec
tions
Antip
arkin
son,
Ant
ivira
lNo
t Ins
urab
leSy
nthr
oid
Levo
thyr
oxin
eTh
yroi
d Pr
epar
atio
nsHo
rmon
eUs
ually
Ultr
a
TTa
ceCa
ncer
Not I
nsur
able
Tacr
ine
Tacr
ine
Mem
ory
Loss
Anti-
Alzh
eirm
erNo
t Ins
urab
leTa
crol
imus
Tacr
olim
usDi
seas
esIm
mun
osup
pres
sant
Not I
nsur
able
Taga
met
Cim
etid
ine
Gast
roin
test
inal
Antiu
lcer A
gent
Usua
lly U
ltra
Talw
inPe
ntaz
ocin
eNa
rcot
ic Pa
in M
edica
tion
Opio
id A
nalg
esic
Not I
nsur
able
Tam
boco
rFle
cain
ide
Card
iac
Antia
rrhyt
hmic
Othe
r tha
n Ul
traTa
mot
idin
eTa
mot
idin
eGa
stro
inte
stin
alAn
iulce
r Age
ntUs
ually
Ultr
aTa
mox
ifen
Brea
st C
ance
rOt
her t
han
Ultra
Tara
ctan
Antip
sych
otics
Not I
nsur
able
Taxo
lCa
ncer
Canc
erNo
t Ins
urab
leTe
gret
olCa
rbam
azep
ine
Neur
algi
aAn
ticon
vulsa
ntOt
her t
han
Ultra
Telm
isarta
nTe
lmisa
rtan
Hype
rtens
ion
Antih
yper
tens
iveUs
ually
Ultr
aTe
nex
Guan
facin
eCa
rdia
cAn
tihyp
erte
nsive
Usua
lly U
ltra
FOR
PROD
UCER
USE
ON
LY. N
OT F
OR U
SE W
ITH
THE
PUBL
IC.
78
Drug
-Gen
eric
Ge
neric
Nam
eDe
scrip
tion/
Ther
apeu
tic C
lass
Prob
able
Act
ion
& T
rade
Nam
esCo
nditi
ons
Trea
ted
Teno
retic
Card
iac
Antih
yper
tens
iveUs
ually
Ultr
aTe
norm
inCa
rdia
cAn
tihyp
erte
nsive
Usua
lly U
ltra
Tera
zosin
Tera
zosin
Card
iac,
Pros
tate
Enl
arge
men
tAn
tihyp
erte
nsive
, BPH
Usua
lly U
ltra
Terb
utal
ine
Terb
utal
ine
Resp
irato
ry In
hale
rBr
onch
odila
tor
Othe
r tha
n Ul
traTe
rfluz
ine
Trifl
uope
razin
eAn
tipsy
chot
icsAn
tipsy
chot
icsNo
t Ins
urab
leTe
vete
nEp
rosa
rtan
Card
iac
Antih
yper
tens
iveUs
ually
Ultr
aTh
eo-2
4Th
eoph
yllin
eRe
spira
tory
Bron
chod
ilato
rOt
her t
han
Ultra
Theo
bid
Theo
phyll
ine
Resp
irato
ryBr
onch
odila
tor
Othe
r tha
n Ul
traTh
eocle
arTh
eoph
yllin
eRe
spira
tory
Bron
chod
ilato
rOt
her t
han
Ultra
Theo
-Dur
Theo
phyll
ine
Resp
irato
ryBr
onch
odila
tor
Othe
r tha
n Ul
traTh
eola
irTh
eoph
yllin
eRe
spira
tory
Bron
chod
ilato
rOt
her t
han
Ultra
Theo
phyll
ine
Theo
phyll
ine
Resp
irato
ryBr
onch
odila
tor
Othe
r tha
n Ul
traTh
eosp
anTh
eoph
yllin
eRe
spira
tory
Bron
chod
ilato
rOt
her t
han
Ultra
Theo
vent
Theo
phyll
ine
Resp
irato
ryBr
onch
odila
tor
Othe
r tha
n Ul
traTh
iorid
azin
eTh
iorid
azin
eSc
hizo
phre
nia
Antip
sych
otic
Not I
nsur
able
Thor
azin
eCh
lorp
rom
azin
ePs
ycho
ses
Antip
sych
otics
, Ant
iem
etic
Not I
nsur
able
Thyr
arTh
yroi
dTh
yroi
d Pr
epar
atio
nsHo
rmon
eUs
ually
Ultr
aTh
yroi
dTh
yroi
dTh
yroi
d Pr
epar
atio
nsHo
rmon
eUs
ually
Ultr
aTh
yrol
arLio
trix
Thyr
oid
Prep
arat
ions
Horm
one
Usua
lly U
ltra
Tiam
ate
Dilti
azem
Card
iac-
Calci
um C
hann
el B
lock
erAn
tihpe
rtens
ives
Usua
lly U
ltra
Tiaza
cDi
ltiaz
emCa
rdia
c-Ca
lcium
Cha
nnel
Blo
cker
Antih
perte
nsive
sUs
ually
Ultr
aTig
anTr
imet
hobe
nzam
ide
Naus
ea a
nd V
omiti
ngAn
tiem
etics
Usua
lly U
ltra
Timol
ide
Com
boCa
rdia
cAn
tihyp
erte
nsive
Usua
lly U
ltra
Tipra
min
eIm
ipra
min
eDe
pres
sion
Antid
epre
ssan
tOt
her t
han
Ultra
Tirof
iban
Tirof
iban
Card
iac
Antip
late
let A
gent
Othe
r tha
n Ul
traTo
cain
ide
Toca
inid
eCa
rdia
cAn
tiarrh
ythm
icsOt
her t
han
Ultra
Tofra
nil
Imip
ram
ine
Depr
essio
nAn
tidep
ress
ant
Othe
r tha
n Ul
traTo
lbut
amid
eDi
abet
esAn
tidia
betic
Othe
r tha
n Ul
tra
FOR
PROD
UCER
USE
ON
LY. N
OT F
OR U
SE W
ITH
THE
PUBL
IC.
79
Drug
-Gen
eric
Ge
neric
Nam
eDe
scrip
tion/
Ther
apeu
tic C
lass
Prob
able
Act
ion
& T
rade
Nam
esCo
nditi
ons
Trea
ted
Tolca
pone
Park
inso
n’s D
iseas
eNo
t Ins
urab
leTo
lmet
inTo
lmet
inAr
thrit
is, P
ain
NSAI
D, A
ntirh
eum
atic
Othe
r tha
n Ul
traTo
ltero
dine
Tolte
rodi
neUr
inar
y-Bl
adde
rAn
ticho
liner
gic
Usua
lly U
ltra
Tono
card
Toca
inid
eCa
rdia
cAn
tiarrh
ythm
icsOt
her t
han
Ultra
Topa
max
Topi
ram
ate
Seizu
re D
isord
erAn
ticon
vulsa
ntOt
her t
han
Ultra
Topi
ram
ate
Topi
ram
ate
Seizu
re D
isord
erAn
ticon
vulsa
ntOt
her t
han
Ultra
Topr
olM
etop
rolo
lCa
rdia
cAn
tiang
inal
, Ant
ihyp
erte
nsive
Usua
lly U
ltra
Tora
dol
Arth
ritis
Othe
r tha
n Ul
traTo
rsem
ide
Tors
emid
eEd
ema
Diur
etic
Usua
lly U
ltra
Trac
leer
Bose
ntan
Card
iac
Pulm
onar
y hy
perte
nsio
nNo
t Ins
urab
leTr
ando
lapr
ilTr
ando
lapr
ilCa
rdia
cAn
tihyp
erte
nsive
Usua
lly U
ltra
Tran
sder
m-N
itro
Nito
glyc
erin
Card
iac-
Nitra
teAn
ti-An
gina
lOt
her t
han
Ultra
Tran
sder
m-S
cpSc
opal
amin
eM
otio
n Si
ckne
ss (T
rans
derm
al)
Anite
met
icUs
ually
Ultr
aTr
anxe
neAn
xiety
Othe
r tha
n Ul
traTr
anylc
ypro
min
eTr
anylc
ypro
min
eDe
pres
sion
Antid
epre
ssan
t-MAO
Inib
itors
Othe
r tha
n Ul
traTr
azad
one
Traz
odon
eDe
pres
sion
Antid
epre
ssan
tOt
her t
han
Ultra
Trex
all
Met
hotre
xate
Rheu
mat
oid
Arth
ritis
DMAR
D, Im
mun
osup
pres
sant
Othe
r tha
n Ul
traTr
ialo
dine
Traz
odon
eDe
pres
sion
Antid
epre
ssan
tOt
her t
han
Ultra
Tria
mcin
olon
e In
hale
rTr
iam
cinol
one
Inha
ler
Resp
irato
ry In
hale
rCo
rtico
rste
roid
Inha
ler,
Antia
sthm
atic
Othe
r tha
n Ul
traTr
iam
olon
eTr
iam
cinol
one
Ster
oid
Antia
sthm
atic,
Cor
ticos
tero
idOt
her t
han
Ultra
Tria
mte
rene
Tria
mte
rene
Edem
aDi
uret
ic, P
otas
sium
-Spa
ring
Usua
lly U
ltra
Tria
vilPe
rphe
nazin
e/Am
itrip
tylin
eDe
pres
sion
Othe
r tha
n Ul
traTr
icor
Feno
fibra
teHy
perc
hole
ster
olem
iaLip
id-(f
at)-L
ower
ing
drug
Usua
lly U
ltra
Trico
sal
Chol
ine/
Mag
nesiu
m S
alicy
late
Arth
ritis,
Pai
nNS
AID
Othe
r tha
n Ul
traTr
idil
Nito
glyc
erin
Card
iac-
Nitra
teAn
ti-An
gina
lOt
her t
han
Ultra
Trid
ione
Seizu
re D
isord
erOt
her t
han
Ultra
Trifl
uope
razin
eTr
ifluo
pera
zine
Antip
sych
otics
Antip
sych
otics
Not I
nsur
able
Trih
exan
eTr
ihex
yphe
nidy
lPa
rkin
son’s
Antip
arkin
son
Not I
nsur
able
FOR
PROD
UCER
USE
ON
LY. N
OT F
OR U
SE W
ITH
THE
PUBL
IC.
80
Drug
-Gen
eric
Ge
neric
Nam
eDe
scrip
tion/
Ther
apeu
tic C
lass
Prob
able
Act
ion
& T
rade
Nam
esCo
nditi
ons
Trea
ted
Trih
exyp
heni
dyl
Trih
exyp
heni
dyl
Park
inso
n’sAn
tipar
kinso
nNo
t Ins
urab
leTr
ilafo
nAn
tipsy
chot
icsNo
t Ins
urab
leTr
iiodo
thyr
onin
e Lio
thyr
onin
e Th
yroi
d Pr
epar
atio
ns
Horm
one
Usua
lly U
ltra
Trile
ptal
Oxca
rbaz
epin
eSe
izure
Diso
rder
Antic
onvu
lsant
Othe
r tha
n Ul
traTr
ilisa
teCh
olin
e/M
agne
sium
Sal
icyla
teAr
thrit
is, P
ain
NSAI
DOt
her t
han
Ultra
Trio
stat
Lioth
yron
ine
Thyr
oid
Prep
arat
ions
Horm
one
Usua
lly U
ltra
Trite
cRa
nitid
ine
Bism
uth
Citra
teGa
stro
inte
stin
alAn
tiulce
r Age
ntUs
ually
Ultr
aTr
uphy
lline
Amin
ophy
lline
Resp
irato
ryBr
onch
odila
tor
Othe
r tha
n Ul
traTy
lox
Oxyc
odon
e/Ac
etam
inop
hen
Narc
otic
Pain
Med
icatio
nOp
ioid
Ana
lges
icNo
t Ins
urab
leTy
sabr
iM
ultip
le S
clero
sisM
ultip
le S
clero
sisNo
t Ins
urab
le
UUl
tram
Narc
otic
pain
med
icatio
nNo
t Ins
urab
leUl
trazin
ePr
ochl
orpe
razin
ePs
ycho
ses
Antie
met
ic, A
ntip
sych
otic
Not I
nsur
able
Unip
hyl
Theo
phyll
ine
Resp
irato
ryBr
onch
odila
tor
Othe
r tha
n Ul
traUn
ivasc
Moe
xipril
Card
iac
Antih
yper
tens
iveUs
ually
Ultr
aUr
abet
hBe
than
ecol
Urin
ary-
Blad
der
Urin
ary
Trac
t Stim
ulan
tUs
ually
Ultr
aUr
echo
line
Beth
anec
olUr
inar
y-Bl
adde
rUr
inar
y Tr
act S
timul
ant
Usua
lly U
ltra
Urise
dUr
inar
y-Bl
adde
rUs
ually
Ultr
aUr
ispas
Urin
ary-
Blad
der
Usua
lly U
ltra
Urso
Cirrh
osis
Not I
nsur
able
VVa
ldec
oxib
Vald
ecox
ibAr
thrit
is, P
ain
NSAI
DOt
her t
han
Ultra
Valiu
mDi
azep
amRe
laxa
ntOt
her t
han
Ultra
Valp
roat
e So
dium
Valp
roat
e So
dium
Seizu
re D
isord
erAn
ticon
vulsa
nt, V
ascu
lar H
eada
ches
Othe
r tha
n Ul
tra
FOR
PROD
UCER
USE
ON
LY. N
OT F
OR U
SE W
ITH
THE
PUBL
IC.
81
Drug
-Gen
eric
Ge
neric
Nam
eDe
scrip
tion/
Ther
apeu
tic C
lass
Prob
able
Act
ion
& T
rade
Nam
esCo
nditi
ons
Trea
ted
Valp
roic
Acid
Valp
roic
Acid
Seizu
re D
isord
erAn
ticon
vulsa
nt, V
ascu
lar H
eada
ches
Othe
r tha
n Ul
traVa
lsarta
nVa
lsarta
nHy
perte
nsio
nAn
tihpe
rtens
iveUs
ually
Ultr
aVa
nado
mCa
risop
rodo
lM
uscle
Spa
sms
Skel
etal
Mus
cle R
elax
ant
Othe
r tha
n Ul
traVa
ncer
il In
hale
rBe
clom
etha
sone
Inha
ler
Resp
irato
ry In
hale
rCo
rtico
rste
roid
Inha
ler,
Antia
sthm
atic
Othe
r tha
n Ul
traVa
scor
Bepr
idil
Card
iac-
Calci
um C
hann
el B
lock
erAn
ti-An
gina
lOt
her t
han
Ultra
Vase
retic
Com
boCa
rdia
cAn
tihyp
erte
nsive
Usua
lly U
ltra
Vaso
tec
Enal
april
/Ena
lapr
ilat
Card
iac
Antih
yper
tens
iveUs
ually
Ultr
aVe
nlaf
axin
eVe
nlaf
axin
eDe
pres
sion
Antia
nxie
ty, A
ntid
epre
ssan
tOt
her t
han
Ultra
Vent
olin
Albu
tero
lRe
spira
tory
Bron
chod
ilato
rOt
her t
han
Ultra
Vico
din
Acet
amin
ophe
n/Hy
droc
odon
eNa
rcot
ic Pa
in M
edica
tion
Anal
gesic
Call
Vita
min
BFo
lic A
cidAn
emia
, Vita
min
Anti-
Anem
icUs
ually
Ultr
aVi
vact
ilDe
pres
sion
Antip
sych
otic
Not I
nsur
able
Volm
axAl
bute
rol
Resp
irato
ryBr
onch
odila
tor
Othe
r tha
n Ul
traVo
ltare
nDe
clofe
nac
Arth
ritis
NSAI
DOt
her t
han
Ultra
WW
arfa
rinW
arfa
rinBl
ood
Thin
ner
Antic
oagu
lant
Othe
r tha
n Ul
traW
elch
olCo
lese
vela
mHy
perc
hole
ster
olem
iaLip
id-(f
at)-L
ower
ing
drug
Usua
lly U
ltra
Wel
lbut
rinBu
prop
ion
Depr
essio
n, S
mok
ing
Cess
atio
nAn
itdep
ress
ant,
Smok
ing
Dete
rrant
Othe
r tha
n Ul
traW
esth
roid
Thyr
oid
Thyr
oid
Prep
arat
ions
Horm
one
Usua
lly U
ltra
Wig
rain
e Su
ppos
itorie
sEr
gota
min
e/Ca
ffein
e Co
mbo
Mig
rain
esVa
soco
nstri
ctor
Usua
lly U
ltra
Wyg
esic
Prop
oxyp
hene
/Ace
tam
inop
hen
Narc
otic
Pain
Med
icatio
nOp
ioid
Ana
lges
icCa
llW
yten
sinGu
anab
enz
Card
iac
Antih
yper
tens
iveUs
ually
Ultr
a
XXa
nax
Alpr
azol
amAn
xiety
-Ben
zodi
azep
ine
Antia
nxie
tyOt
her t
han
Ultra
FOR
PROD
UCER
USE
ON
LY. N
OT F
OR U
SE W
ITH
THE
PUBL
IC.
82
Drug
-Gen
eric
Ge
neric
Nam
eDe
scrip
tion/
Ther
apeu
tic C
lass
Prob
able
Act
ion
& T
rade
Nam
esCo
nditi
ons
Trea
ted
Xope
nex
Leva
lbut
erol
Resp
irato
ry In
hale
rBr
onch
odila
tor
Othe
r tha
n Ul
tra
ZZa
ntac
Rani
tidin
eGa
stro
inte
stin
alAn
tiulce
r Age
ntUs
ually
Ultr
aZa
roxo
lynM
etol
azon
eCa
rdia
c, Ed
ema
Antih
yper
tens
ive, D
iure
ticUs
ually
Ultr
aZe
beta
Biso
prol
olCa
rdia
c- B
eta
Bloc
ker
Antih
yper
tens
iveUs
ually
Ultr
aZe
stor
etic
Com
boCa
rdia
cAn
tihyp
erte
nsive
Usua
lly U
ltra
Zest
rilLis
inop
rilCa
rdia
cAn
tihyp
erte
nsive
Usua
lly U
ltra
Ziac
Card
iac
Antih
yper
tens
iveUs
ually
Ultr
aZi
leut
onZi
leut
onRe
spira
tory
Bron
chod
ilato
rOt
her t
han
Ultra
Zipr
asid
one
Zipr
asid
one
Schi
zoph
reni
aAn
tipsy
chot
icNo
t Ins
urab
leZo
cor
Sim
vast
atin
Hype
rcho
lest
erol
emia
Lipid
-(fat
)-Low
erin
g dr
ugUs
ually
Ultr
aZo
lade
xGo
sere
linCa
ncer
, Pro
stat
e an
d Br
east
Antin
eopl
astic
Not I
nsur
able
Zole
dron
ic Ac
idZo
ledr
onic
Acid
Mul
tiple
Mye
lom
aHy
poca
lcem
icNo
t Ins
urab
leZo
lmitr
ipta
nZo
lmitr
ipta
nM
igra
ines
Vasc
ular
Hea
dach
e Su
ppre
ssan
tUs
ually
Ultr
aZo
loft
Sertr
alin
eDe
pres
sion
Antid
epre
ssan
tOt
her t
han
Ultra
Zolp
idem
Zolp
idem
Slee
ping
pill
Seda
tive/
Hypn
otic
Usua
lly U
ltra
Zom
eta
Zole
dron
ic Ac
idM
ultip
le M
yelo
ma
Hypo
calce
mic
Not I
nsur
able
Zom
igZo
lmitr
ipta
nM
igra
ines
Vasc
ular
Hea
dach
e Su
ppre
ssan
tUs
ually
Ultr
aZo
nalo
nDo
xepi
nDe
pres
sion
Antid
epre
ssan
tOt
her t
han
Ultra
Zone
gran
Zoni
sam
ide
Seizu
re D
isord
erAn
ticon
vulsa
ntOt
her t
han
Ultra
Zost
rixCa
psai
cinPa
in M
anag
emen
t, To
pica
lNo
nopi
oid
Anal
gesic
s (To
pica
l)Ca
llZo
virax
Acyc
lovir
Herp
es In
fect
ions
Antiv
iral
Usua
lly U
ltra
Zyba
nBu
prop
ion
Depr
essio
n, S
mok
ing
Cess
atio
nAn
itdep
ress
ant,
Smok
ing
Dete
rrant
Othe
r tha
n Ul
traZy
done
Hydr
ocod
one/
Acet
amin
ophe
nNa
rcot
ic Pa
in M
edica
tion
Opio
id A
nalg
esic
Not I
nsur
able
Zyflo
Zile
uton
Resp
irato
ryBr
onch
odila
tor
Othe
r tha
n Ul
traZy
lopr
imAl
lopu
rinol
Gout
Antig
out A
gent
Usua
lly U
ltra
Zypr
exa
Olan
zapi
neSc
hizo
phre
nia,
Anr
oexia
Ner
vosa
Antip
sych
otic
Not I
nsur
able
FOR
PROD
UCER
USE
ON
LY. N
OT F
OR U
SE W
ITH
THE
PUBL
IC.
83
Drug
-Gen
eric
Ge
neric
Nam
eDe
scrip
tion/
Ther
apeu
tic C
lass
Prob
able
Act
ion
& T
rade
Nam
esCo
nditi
ons
Trea
ted
FOR PRODUCER USE ONLY. NOT FOR USE WITH THE PUBLIC.
84
Notes