5.6 Covered Benefits

The Mandatory Generic Prescription Drug Plan covers the following services and materials:

1. Federal legend drugs: Any medicinal substance which bears the legend, "Caution: Federal law prohibits dispensing without a prescription;"
2. State-restricted drugs: Any medicinal substance, which may be dispensed by prescription only according to state law;
3. Federal legend oral contraceptives and birth control pills;
4. Contraceptive products, including, but not limited to diaphragms, cervical caps, Depo-Provera™ injections and Ortho-Evra™ patches;
5. Inhaler extender devices and bags (e.g. Aerochamber™, Aerochamber™ with mask, Easivent™, Inspirsease™, EZ-Spacer™, Optichamber™, Optihaler™, Ellipse™);
6. Anaphylaxis prevention kits, including, but not limited to, Epi-Pen™, Epi-Pen Jr.™, Ana-Kits™, Ana-Kit Jr.™, Glucagon™, Glucagon Emergency Kit™, and Ana-Guard™;
7. Compounds with at least one federal legend or state-restricted ingredient;
8. Normal saline for inhalation and irrigation;
9. Prescription prenatal vitamins; and
10. Injectables (see also Exclusions for exceptions).

The following non-prescription items are also covered when prescribed in writing by a physician and dispensed by a licensed pharmacist:

1. Insulin, insulin syringes and needles;
2. Blood glucose test strips;
3. Urine glucose test strips;
4. Sterile lancets; and
5. Novolin™ pen, Humulin™ pen, pre-filled pens, pen needles and cartridges.