ALERT! Drugs classified as proton pump inhibitors (commonly called PPIs) have over-the-counter alternatives and are not covered under the plan for persons age 18 and over. The plan does cover PPIs for persons under age 18 when prescribed, because the available over-the-counter alternatives are not approved for persons under age 18.
Drugs not covered under the plan include but are not limited to:
- Experimental or investigational drugs
- Dietary supplements, vitamins, minerals, herbal supplements, and medical foods
- Homeopathic drugs, including FDA-approved prescription products
- Dental preparations (such as rinses and pastes)
- Over-the-counter drugs or prescription drugs that have nonprescription alternative, except for the drugs specified under "Guidelines for Drugs Covered." Note: Prescription drugs with a nonprescription alternative, including an over-the-counter alternative having similar safety, efficacy, and ingredients are not covered.
- Drug costs covered by other insurance including Medicare Part B (Medicare retirees, see Prescription Drug Coverage When Medicare Is Primary." For primary plans other than Medicare, see "How does prescription drug coverage work when UMP Classic or UMP CDHP is secondary?")
- Prescription drugs for tobacco cessation, except as authorized by Quit for Life counselors for participants in that program
The plan also does not cover drugs to treat conditions that are not covered under the medical benefit. These include, but aren't limited to, drugs for:
- Cosmetic purposes
- Obesity (or weight loss)
- Sexual dysfunction
The plan covers the following prescription products as exceptions to the above rules:
- Limited products for the treatment of congenital metabolic disorders such as phenylketonuria [PKU] detected by newborn screening when specialized formulas are medically necessary; and
- Elemental formulas for Eosinophilic Gastrointestinal Disorders (EGIDs).
See also the 2015 UMP Expenses Not Covered, Exclusions, and Limitations.