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The formulary list was last updated on 09/01/07, please be advised the information listed may not reflect the most current data and may be updated at any time without notice.
Please call HNE Member Services at (413) 787-4000 or
(800) 310-2835 for assistance.
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Excluded Medications
The following medications are currently NOT covered by Health New England.
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DRUG NAME
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GENERIC NAME
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USED FOR TREATMENT OF
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| Aclaro PD 4% Emulsion |
Avobenz/Octinox/H-Quinine |
Skin Bleaching |
| Aquoral Spray |
Saliva substitute |
dry mouth and throat |
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Avage
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tazarotene
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Facial Wrinkles (Vit A der)
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| Didrex |
benzphetamine |
Weight loss |
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Eldopaque Forte
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hydroquinone
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Skin Bleaching
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Glyquin XM
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hydroquinone
kera/oxbn/avobnz/o-cr/h-quin
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Skin Bleaching
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Lustra
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hydroquinone
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Skin Bleaching
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Melenex
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hydroquinone
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Skin Bleaching
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| OBAGI Nu-Derm |
hydroquinone |
Skin Bleaching |
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Penlac
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ciclopirox
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Fungal Nails (onychomycosis)
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Propecia
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finasteride
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Male Pattern Baldness
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Renova
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trentinoin
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Wrinkles
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| Rogaine |
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Male Pattern Baldness |
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Solage
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hydroquinone
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Skin Bleaching
(Hypopigmentation)
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Solaquin Forte
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hydroquinone
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Skin Bleaching
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Tri-Luma
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flucinolone/tretinoin/hydroquine
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Skin Bleaching
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Vaniqa
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Eflornithine
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Prevention of Facial Hair Growth in Women
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| Various |
hydroquinone, generic |
Skin Bleaching |
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Xyrem
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sodium oxybate
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FDA approved for Cataplexy, however not a covered a benefit
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Newly Approved Drugs
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various
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Various
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Note: This list is subject to change.
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