Page 4 - Insurance-Declinable-Drugs

CANCER HEART OTHER RIDERS

Drug Name Use Flexible Choice Flexible Choice HI/ICU/HICU*
Cancer Treatment Heart
Choriogonadotropin Alfa Infertility Treatments X
Chorionic Gonadotropin Infertility Treatments X X
Cilostazol PeripheralVascular Disease X X
Cimzia Rheumatoid Arthritis, Crohn’s X
Cisplatin Cancer X X
Clomid Infertility Treatments X
Clomifene Infertility Treatments X X
Clomifert Infertility Treatments X X
Clomiphene Citrate Infertility Treatments XX X
Clopidogrel Bisulfate Angina, Heart Attack, Stroke, Peripheral X X
Vascular Disease
Combivent COPD X X
Copaxone Multiple Sclerosis XX X
Cordarone Heart Attack,Ventricular Arrhythmia X
Coumadin Blood Clots X X
Crixivan AIDS X X
Cyclophosphamide Cancer X
Cycloserine Tuberculosis XX X
Cyclosporine OrganTransplant, Immunosuppressant X
Cytoxan Cancer XX X
D4T AIDS X X
Dalteparin Angina, Blood Clots X X
Danaparoid Blood Clots X X
Dantrium Multiple Sclerosis X
Dantrolene Multiple Sclerosis XX X
Darbepoetin Alfa Chronic Renal Failure X X
Delavirdine AIDS X
Depade Alcoholism, Opioids X
Depakote Bipolar Disorder (OK for migraines) X
Depen Rheumatoid Arthritis X
Didanosine AIDS X
Digitek Heart Failure, Atrial Fibrillation X
Digoxin Heart Failure, Atrial Fibrillation X
Dilaudid Narcotic Analgesic X
Dipyridamole PeripheralVascular Disease, X
Heart Disease
Disoproxil Fumarate AIDS X
Disopyramide Phosphate Arrhythmias, Heart Disease X

Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel.
* HI = Hospital Indemnity Rider

ICU = Intensive Care Unit Rider
HICU = Hospital & Intensive Care Unit Rider

4