Charges Not Covered in the Prescription Drug Program
Listed below are medications the MILA National Health
Plan does not cover under the Prescription Drug Program:
- Drugs that do not require prescriptions, such as
over-the-counter remedies, or for which there is
a generic equivalent drug that is available in
non-prescription form;
- Compound prescriptions that do not have at least
one ingredient that is a legend drug requiring a
prescription under federal or state law;
- Drugs that are covered under another part of the
MILA National Health Plan or that are limited or
excluded because they are experimental, investigational
or not medically necessary;
- Drugs that are covered under Workers’ Compensation
or any government program (state, federal or municipal)
that does not claim secondary payer status;
- Drugs or devices for cosmetic purposes, hair growth,
smoking cessation, anti-obesity, weight control, and
contraception except for oral contraceptives and the
specific products Nuva-Ring and Orth-Evra;
- Drugs not approved by the U.S. Food and Drug
Administration (FDA) or not approved by the
FDA for the condition, dose, routine and frequency
for which they are being prescribed;
- Drugs provided at no charge to you or for which
you would not have to pay in the absence of this or
similar coverage;
- Drugs required as a result of an act of war, declared
or undeclared;
- Food, diet and nutritional supplements except
prescription vitamins and minerals; and
- Natural remedies (naturopathic) and homeopathic
services, substances and supplies.
If you have questions about the
Prescription Drug Program or to
determine if a particular medication
is covered, you can call Caremark®
directly at 1-866-875-MILA (6452).
