SelectHealth doesn’t cover all types of drugs and medications. Below you will find exclusions to our pharmacy benefit.
- Appetite suppressants and weight loss medications;
- Certain off-label drug usage, unless the use has been approved by a SelectHealth Medical Director or clinical pharmacist;
- Compound drugs when alternative products are available commercially;
- Cosmetic health and beauty aids;
- Drugs purchased from nonparticipating providers over the Internet;
- Flu symptom medications;
- Drugs and medications purchased through a foreign pharmacy. However, please contact us if you have a special need for medications from a foreign pharmacy (for example, for an emergency while traveling out of the country);
- Human growth hormone for the treatment of idiopathic short stature;
- Infertility medications;
- Medications not meeting the minimum levels of evidence based upon Food and Drug Administration (FDA) approval and/or DrugDex level 2A strength of recommendation and National Comprehensive Cancer Network (NCCN) category 2A, if applicable.
- Minerals, fluoride, and vitamins other than prenatal or when determined to be medically necessary to treat a specifically diagnosed disease;
- Nicotine and smoking cessation medications, except in conjunction with a SelectHealth-sponsored smoking cessation program;
- Over-the-Counter (OTC) medications, except when all of the following conditions are met;
- The OTC medication is listed on the SelectHealth formulary as a covered medication;
- The SelectHealth Pharmacy & Therapeutics Committee has approved the OTC medication as a medically appropriate substitution of a prescription drug or medication; and
- The member has obtained a prescription for the OTC medication from a licensed provider and filled the prescription at a participating pharmacy;