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:

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
  • Infertility
  • Obesity (or weight loss)
  • Sexual dysfunction

Exceptions Covered

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.

noncovered drugs