Page 5 - Insurance-Declinable-Drugs

Drug Name Use CANCER HEART OTHER RIDERS
Flexible Choice Flexible Choice
Disulfiram Alcoholism Cancer Treatment HI/ICU/HICU*
Dolophine Narcotic Heart
Dornase Alfa Cystic Fibrosis X X
Doxorubicin Cancer X X
Duoneb COPD X X X
Edrophonium Chlorides Myasthenia Gravis X X
Efavirenz AIDS X X X
Effient Heart Disease with Angioplasty X X X
Eligard Cancer X X X
Emcyt Cancer X X
Emtricitabine AIDS X X X
Emtriva AIDS X
Epivir AIDS X X X
Epoetin Renal Fialure, Dialysis X X
Epogen Renal Failure, Dialysis X
Epoprostenol Pulmonary Hypertension X X
Ergamisol Cancer X X
Erlotinib Cancer X X
Eskalith Psychosis, Depression X
Estinyl Cancer (OK for other uses) X X
Estramustine Cancer X X
Etaposide Cancer X X
Ethambutol Tuberculosis X X
Etophopos Cancer X X
Etravirine HIV X X
Eulexin Cancer X X
Everolimus Cancer X X
Exemestane Cancer X
Fareston Cancer X X
Faslodex Cancer X
Femara Cancer X
Fentanyl Narcotic Analgesic X
Fertinex Infertility Treatments X
Filgrastim Cancer X
Fingolimod Multiple Sclerosis X
Flolan Pulmonary Hypertension X
Fluphenazine Hydrochloride Psychosis/Depression X
X
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Confidential, unpublished property of Cigna.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

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