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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
|
GENERIC NAME
|
USED FOR TREATMENT OF
|
| Aclaro PD 4% Emulsion |
Avobenz/Octinox/H-Quinine |
Skin Bleaching |
| Aquoral Spray |
Saliva substitute |
dry mouth and throat |
|
Avage
|
tazarotene
|
Facial Wrinkles (Vit A der)
|
| Didrex |
benzphetamine |
Weight loss |
|
Eldopaque Forte
|
hydroquinone
|
Skin Bleaching
|
|
Glyquin XM
|
hydroquinone
kera/oxbn/avobnz/o-cr/h-quin
|
Skin Bleaching
|
|
Lustra
|
hydroquinone
|
Skin Bleaching
|
|
Melenex
|
hydroquinone
|
Skin Bleaching
|
| OBAGI Nu-Derm |
hydroquinone |
Skin Bleaching |
|
Penlac
|
ciclopirox
|
Fungal Nails (onychomycosis)
|
|
Propecia
|
finasteride
|
Male Pattern Baldness
|
|
Renova
|
trentinoin
|
Wrinkles
|
| Rogaine |
|
Male Pattern Baldness |
|
Solage
|
hydroquinone
|
Skin Bleaching
(Hypopigmentation)
|
|
Solaquin Forte
|
hydroquinone
|
Skin Bleaching
|
|
Tri-Luma
|
flucinolone/tretinoin/hydroquine
|
Skin Bleaching
|
|
Vaniqa
|
Eflornithine
|
Prevention of Facial Hair Growth in Women
|
| Various |
hydroquinone, generic |
Skin Bleaching |
|
Xyrem
|
sodium oxybate
|
FDA approved for Cataplexy, however not a covered a benefit
|
|
Newly Approved Drugs
|
various
|
Various
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Note: This list is subject to change.
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