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Mutual of Omaha asserts that the insurance companys refusal to sell him a long-term care policy is based on its categorical exclusion of anyone who is HIV-negative and takes PrEP. Doe asserts that Mutuals blanket exclusion is sexual orientation discrimination because 80% of PrEP users are men.
What does excluded medication mean?
Drugs not listed on the formulary are called non-formulary or excluded drugs. A medication may be excluded from coverage under your pharmacy benefit when it works similarly to another prescription drug or over-the-counter (OTC) medication.
What is an excluded medication?
Most payers and PBMs also publish a formulary exclusion list, which specifies drugs that they will not cover. Changes and additions to these lists are common, and patients are often asked to switch medications midtreatment.
What is a list of drugs approved for coverage?
A formulary is a list of drugs that are covered by your health plan. Each drug in the formulary is listed alongside its tier, which you can use to find out how your plan covers the drug. The formulary also provides details on any authorizations, restrictions or limits that may apply to your coverage.
What is the difference between excluded and non-formulary?
There are certain kinds of drugs that are excluded from Medicare coverage by law. Medicare does not cover: Drugs used to treat anorexia, weight loss, or weight gain. Note: Part D may cover drugs used to treat physical wasting caused by AIDS, cancer, or other diseases.
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