Appendix G - Exclusions

Certain drug products are not within the scope of the program. These products will not be reimbursed as benefits under the NIHB Program:

• Anti-obesity drugs;
• Household products (regular soaps and shampoos);
• Cosmetics;
• Alternative therapies, including glucosamine and evening primrose oil;
• Megavitamins;
• Drugs with investigational/experimental status;
• Vaccinations for travel indications;
• Hair growth stimulants;
• Fertility agents and impotence drugs;
• Selected over-the-counter products;
• Opioid containing cough preparations;
• Dalmane®, Somnol®and generics (flurazepam);
• Darvon®and 642®(propoxyphene);
• Fiorinal®, Fiorinal®C ¼, Fiorinal®C ½ and generics (Butalbital containing analgesics with and without
• codeine);
• Librium®, Solium®, Medilium®and generics (chlordiazepoxide);
• Stadol TM NS and generics (butorphanol tartrate nasal spray);
• Tranxene®and generics (clorazepate); and
• Imovane®and generics (zopiclone).

The following drugs are excluded from the NIHB Program as recommended by the Common Drug Review (CDR) and the NIHB Drugs and Therapeutics Advisory Committee (DTAC) because published evidence does not support the clinical value or cost of the drug relative to existing therapies, or there is insufficient clinical evidence to support coverage.

Of Note: The Appeal Process and the Emergency Supply Policy will not apply for the following drug products.