Kaiser Permanente Commercial HMO Drug Exclusion List

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Meredith McCormick
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glumet Kaiser Permanente Commercial HMO Drug Exclusion List The following is a list of drugs and drug entities that are excluded from prescription benefit coverage. Prior authorization will not apply.

1 glumet Kaiser Permanente Commercial HMO Drug Exclusion List The following is a list of drugs and drug entities that are excluded from prescription benefit coverage. Prior authorization will not apply. Kasier Permanente reserves the right to exclude any drug at any time from the Kaiser Permanente Colorado Formulary for health and safety concerns or other reasons as determined by Kaiser Permanente at its discretion. If you have questions about the formulary status of a medication, or your prescription benefits, please call our Member Services Department at (toll free). For the hearing or speech impaired: (toll free TTY). This list is subject to change at any time. EXCLUSION CRITERIA: o Drugs and supplies for cosmetic purposes o Drugs for the promotion, prevention, or other treatment of hair loss or growth o Drugs related to non-covered services o Drugs to enhance athletic performance o Drugs to shorten the duration of the common cold o Drugs to treat infertility* o Drugs to treat sexual dysfunction* o Drugs used in the treatment of weight management* o Medical supplies such as dressings and antiseptics o Nonprescription drugs, unless otherwise noted o Packaging of drugs other than the dispensing pharmacy s standard packaging o Prescription drugs for which there is a nonprescription equivalent available, unless otherwise noted o Prescriptions filled at a non-plan pharmacy, except for emergencies as described in your EOC o Replacement of lost, stolen or damaged prescription drugs and/or devices o Vaccines (usually covered under medical) o Vitamins and nutritional supplements that can be purchased without a prescription o Medical service drugs o Any drug being used for a non-approved indication o Medical foods and medical devices *

2 1ST GENERATION ANTIHISTAMINE-DECONGESTANT- ANALGESIC COMBINATIONS 1ST GENERATION ANTIHISTAMINE-DECONGESTANT- ANALGESIC, SALICYLATE 1ST GENERATION ANTIHISTAMINE-DECONGESTANT- ANALGESIC-EXPECTORANT COMBINATIONS 1ST GENERATION ANTIHISTAMINE-DECONGESTANT- EXPECTORANT COMBINATIONS 1ST GENERATION ANTIHISTAMINE-DECONGESTANT- NSAID, COX NONSPECIFIC 2'-FUCOSYLLACTOSE, LACTO-N-NEOTETRAOSE 2ND GENERATION ANTIHISTAMINE 2ND GENERATION ANTIHISTAMINE-DECONGESTANT ACANYA GEL (TOPICAL) ACETAMINOPHEN-GUAIFENESIN ACETIC ACID (IRRIGATION) ACRIVASTINE & PSEUDOEPHEDRINE ACTIVE-PAC/GABAPENTIN THPK (PACK) ACYCLOVIR-HYDROCORTISONE (TOPICAL) ADASUVE (INH) ADDYI (2) ALLEGRA ALLEGRA-D ALPROSTADIL (INJ) (2) ANALGESIC, NON-SALICYLATE-1ST GENERATION ANTIHISTAMINE ANALGESIC, NON-SALICYLATE-EXPECTORANT COMBINATIONS ANALGESICS, MIXED-1ST GENERATION ANTIHISTAMINE ANTITUSSIVES, NON-NARCOTIC APPTRIM APPTRIM-D ARIPIPRAZOLE LAUROXIL (INJ) AVAILNEX AXONA BENZPHETAMINE HCL (3) BETAMETHASONE SOD PHOSPHATE & ACETATE (KIT) BETAQUIK BIMATOPROST (TOPICAL) BOTOX COSMETIC (INJ) BROMPHENIRAMINE-ACETAMINOPHEN BULK PRODUCTS * BUPRENORPHINE HCL (KIT) CAMPHOR (INH) CAMPHOR-EUCALYPTUS-MENTHOL (INH) CAPXIB (KIT) CARDIOTEK RX CARISOPRODOL CARISOPRODOL W/ ASPIRIN & CODEINE CARISOPRODOL W/ ASPIRIN CATHETERS (DEVICE) CAVERJECT (INJ) (2) CELECOXIB-CAPSAICIN-MENTHOL (KIT) CETIRIZINE HCL CETRORELIX ACETATE (KIT) CHLORHEXIDINE GLUCONATE-MUPIROCIN- DIMETHICONE-SILICONE (KIT) KPCO Commercial HMO Drug Exclusion List Page 2 of 9 Revision date: January 1, 2018

3 CHLORPHENIRAMINE-ACETAMINOPHEN CHLORPHENIRAMINE-PHENYLEPHRINE- ACETAMINOPHEN CHLORPHENIRAMINE-PHENYLEPHRINE-ASPIRIN CHLORPHENIRAMINE-PHENYLEPHRINE-IBUPROFEN CHLORPHENIRAMINE-PSEUDOEPHEDRINE-IBUPROFEN CHORIOGONADOTROPIN ALFA (INJ) CHORIONIC GONADOTROPIN (INJ) CIALIS (2) CICLOPIROX (KIT) CICLOPIROX-UREA (PACK) CLIN SINGLE USE (KIT) CLINDAMYCIN PHOSPHATE-BENZOYL PEROXIDE & MOISTURIZER (KIT) CLINDAMYCIN PHOSPHATE-TRETINOIN (TOPICAL) CLINDAREACH (KIT) CLODAN KIT (TOP) CLOMIPHENE CITRATE COSMETIC PRODUCTS * COUGH AND/OR COLD PREPARATIONS CYANOCOBALAMIN (KIT) CYCLOBENZAPRINE HCL W/ LINIMENT (KIT) CYCLOBENZAPRINE-CAPSAICIN-MENTHOL (PACK) DECONGESTANT-ANALGESIC, NON-SALICYLATE COMBINATIONS DECONGESTANT-ANALGESIC-EXPECTORANT COMBINATIONS DECONGESTANT-EXPECTORANT COMBINATIONS DECONGESTANT-NSAID, COX NON-SPECIFIC COMBINATIONS DEPLIN DERMACINRX SILAPAK (KIT) DERMACINRX TICANASE (NASAL) DERMAPAK PAK PLUS (TOPICAL) DERMASORB HC (KIT) DERMASORB TA (KIT) DESLORATADINE DESLORATADINE-PSEUDOEPHEDRINE DEXBROMPHENIRAMINE-ACETAMINOPHEN DEXBROMPHENIRAMINE-PHENYLEPHRINE- ACETAMINOPHEN DEXLIDO (KIT) DEXLIDO-M (KIT) DEXTROMETHORPHAN DEXTROMETHORPHAN-BENZOCAINE DEXTROMETHORPHAN-BENZOCAINE-MENTHOL DEXTROMETHORPHAN-MENTHOL DICLOFENAC SODIUM & ADHESIVE SHEETS (PACK) DICLOFENAC SODIUM & OCCLUSIVE DRESSING (TOPICAL) DICLOFENAC SODIUM & RANITIDINE HCL & LIDOCAINE-PRILOCAINE (PACK) DICLOFENAC SODIUM (KIT) DICLOFENAC SODIUM-BENZALKONIUM CHLORIDE (PACK) DICLOFENAC SODIUM-CAMPHOR-MENTHOL-METHYL SALICYLATE (KIT) DICLOFENAC SODIUM-CAPSAICIN (PACK) DICLOFENAC SODIUM-CAPSAICIN (TOPICAL) DICLOFENAC SODIUM-RANITIDINE HCL-CAPSAICIN (PACK) KPCO Commercial HMO Drug Exclusion List Page 3 of 9 Revision date: January 1, 2018

4 DICLOFENAC SODIUM-RANITIDINE HCL-LIDOCAINE (PACK) DIETARY MANAGEMENT PRODUCTS * DIETHYLPROPION HCL DIHYDROXYACETONE (TOPICAL) DIPHENHYDRAMINE-ACETAMINOPHEN DIPHENHYDRAMINE-PHENYLEPHRINE- ACETAMINOPHEN DMT SUIK (KIT) DNA COLLECTION PRODUCT (KIT) DOLOTRANZ (KIT) DOUBLEDEX (KIT) DOXYCYCLINE HYCLATE W/ CLEANSER (KIT) DOXYLAMINE-PHENYLEPHRINE-ACETAMINOPHEN DUEXIS EDEX (INJ) (2) ELFOLATE ELIGEN B12 EMOLLIENT-SKIN MOISTURIZERS (TOPICAL) ENLYTE ENTERAGAM ENTERAL NUTRITION (SUPPLIES) EPHEDRINE-GUAIFENESIN EPICERAM EMUL (TOP) ESOMEPRAZOLE MAGNESIUM EXPECTORANTS EXPECTORANTS, COMBINATIONS FASENRA (INJ) FEEDING TUBES/SETS (DEVICE) FERREX 150 FORTE PLUS FEXOFENADINE HCL FEXOFENADINE-PSEUDOEPHEDRINE FIBER-STAT FINASTERIDE (ALOPECIA) FOLBIC FOLIC ACID-CYANOCOBALMIN-PYRIDOXINE FOLLITROPIN ALFA (INJ) FOLLITROPIN BETA (INJ) FORTAMET FOSTEUM FOSTEUM PLUS FOVEX GABADONE GANIRELIX ACETATE (INJ) GLUMETZA GOSERELIN ACETATE (IMPLANT) GUAIFENESIN HALAC (KIT) HALONATE (KIT) HALOPERIDOL DECANOATE (INJ) HEPATITIS B IMMUNE GLOBULIN (HUMAN) (INJ) HYDROQUINONE (TOPICAL) HYDROQUINONE MICROSPHERES (TOPICAL) HYDROQUINONE W/ SUNSCREENS (TOPICAL) KPCO Commercial HMO Drug Exclusion List Page 4 of 9 Revision date: January 1, 2018

5 HYDROXYPROGESTERONE CAPROATE (ANTINEOPLASTIC) (INJ) HYPERTENSA IBUPROFEN (OTC EQUIV) IBUPROFEN W/ LINIMENT (KIT) IMMUNE GLOBULIN (HUMAN) (INJ) INCONTINENCE SUPPLIES/WOUND CARE DRAINAGE (SUPPLIES) INFERTILITY DRUGS INHALER, SPACER/CHAMBER (DEVICE) IN-OFFICE ADMINISTERED PRODUCTS * INTRAROSA (VAG) INTRAROSA INST (VAG) INTRA-UTERINE DEVICES (IUDS) INTRAVENOUS INJECTIONS * INVEGA SUSTENNA SUSP (INJ) INVEGA TRINZA SUSP (INJ) ISOVACTIN AA PLUS BERRY IV CATHETER (SUPPLIES) IV SETS/TUBING (SUPPLIES) KARAYA GUM (TOPICAL) KETOCAL 3:1 POWDER KETOCAL 4:1 LQ KETOCAL 4:1 POWDER KETOCONAZOLE & CLEANSER (KIT) KETODAN (KIT) KETOROCAINE-L (KIT) KETOROCAINE-LM (KIT) KETOROLAC TROMETHAMINE (INJ) KETOTIFEN FUMARATE (OPHTH) KETOVIE 4:1 KETOVIE PEPTIDE LANSOPRAZOLE (OTC EQUIV) LETROZOLE LEUPROLIDE ACETATE & NORETHINDRONE ACETATE (KIT) LEUPROLIDE ACETATE (INJ) LEVITRA (2) LEVOCETIRIZINE DIHYDROCHLORIDE LEVONORGESTREL (EMERGENCY OC) OTC LEVONORGESTREL IUD (DEVICE) LIDOCAINE-PENTAFLUOROPROP-TETRAFLUOROETH- ULTRASOUND (KIT) LIDOCAINE-PRILOCAINE (KIT) LIDOCAINE-PRILOCAINE-MENTHOL-METHYL SALICYLATE (KIT) LIDOCAINE-PRILOCAINE-SODIUM CHLORIDE (KIT) LIDOCAINE-TRANSPARENT DRESSING (KIT) LIDOPAC (KIT) LIMBREL LIPISTART LIQUIGEN LIRAGLUTIDE (WEIGHT MANAGEMENT) (INJ) LISTER-V LORCASERIN HCL LORVATUS PHARMAPAK (KIT) LOXAPINE (INH) KPCO Commercial HMO Drug Exclusion List Page 5 of 9 Revision date: January 1, 2018

6 LUKAID GLA LUNGLAID MAKENA (INJ) MARDEX-25 (KIT) MCT OIL MECLIZINE HCL MEDROXYPROGESTERONE ACETATE SUSP (INJ) MELOXICAM W/ LINIMENT (KIT) MEMANTINE HCL-DONEPEZIL HCL MENOTROPINS (INJ) MENTHOL (MOUTH-THROAT) MIACALCIN (INJ) MICONAZOLE NITRATE (VAG) MINOXIDIL (TOPICAL) MIRVASO GEL (TOPICAL) MISC NATURAL WEIGHTLOSS PRODUCTS MONOBENZONE (TOPICAL) MONOGEN MUGARD MULTIPLE VITAMINS W/ MINERALS & FOLIC ACID MUSE PELLETS (IMPLANT) (2) NALTREXONE (INJ) NALTREXONE HCL-BUPROPION HCL NAMZARIC CP24 NAPROPAK (PACK) NAPROXEN SODIUM-MENTHOL (PACK) NAPROXEN W/ LINIMENT (KIT) NAPROXEN-CAPSAICIN-MENTHOL (KIT) NAPROXEN-ESOMEPRAZOLE MAGNESIUM NEOCATE JUNIOR NEOCATE JUNIOR WITH PREBIOTICS NEOCATE NUTRA NEOCATE'S E028 SPLASH NEO-SYNALAR (KIT)Bottom of Form NEUAC (KIT) NEUREMEDY NEXIUM NEXPLANON CONTRACEPTIVE IMPLANT NICAZELDOXY 30 (KIT) NON-NARCOTIC ANTITUSSIVE-1ST GENERATION ANTIHISTAMINE COMBINATIONS NON-NARCOTIC ANTITUSSIVE-1ST GENERATION ANTIHISTAMINE-ANALGESIC COMBINATIONS NON-NARCOTIC ANTITUSSIVE-1ST GENERATION ANTIHISTAMINE-DECONGESTANT NON-NARCOTIC ANTITUSSIVE-1ST GENERATION ANTIHISTAMINE-DECONGESTANT-ANALGESIC COMBINATIONS NON-NARCOTIC ANTITUSSIVE-1ST GENERATION- DECONGESTANT-SALICYLATE NON-NARCOTIC ANTITUSSIVE-ANALGESIC COMBINATIONS NON-NARCOTIC ANTITUSSIVE-DECONGESTANT COMBINATIONS NON-NARCOTIC ANTITUSSIVE-DECONGESTANT- ANALGESIC COMBINATIONS NON-NARCOTIC ANTITUSSIVE-DECONGESTANT- ANALGESIC-EXPECTORANT COMBINATIONS NON-NARCOTIC ANTITUSSIVE-DECONGESTANT- EXPECTORANT COMBINATIONS NON-NARCOTIC ANTITUSSIVE-EXPECTORANT COMBINATIONS KPCO Commercial HMO Drug Exclusion List Page 6 of 9 Revision date: January 1, 2018

7 NORITATE (TOPICAL) NYSTATIN & EXFOLIATING AGENT (KIT) OMEGA-3/D-3 WELLNESS (KIT) OMEPRAZOLE-SODIUM BICARBONATE ONEXTON GEL (TOPICAL) ORAL SYRINGES (SUPPLIES) ORAL WOUND CARE PRODUCTS ORLISTAT OSPHENA (2) OTC PRODUCTS * OZURDEX OPTHALMIC (IMPLANT) PAINGO KFT (KIT) PAPAVERINE (INJ) (2) PAPAVERINE-ALPROSTADIL (INJ) (2) PAPAVERINE-PHENTOLAMINE (INJ) (2) PAPAVERINE-PHENTOLAMINE-ALPROSTADIL (INJ) (2) PARENTERAL ADMINISTRATION SETS (SUPPLIES) PECTIN (MOUTH-THROAT) PEDIADERM AF (KIT) PEDIADERM HC (KIT) PERCURA PHENAZOPYRIDINE HCL PHENDIMETRAZINE TARTRATE (3) PHENIRAMINE-PHENYLEPHRINE-ACETAMINOPHEN PHENTERMINE HCL (3) PHENTERMINE HCL-TOPIRAMATE (3) PHENTOLAMINE MESYLATE (INJ) (2) PHENTOLAMINE-ALPROSTADIL (INJ) (2) PHENYLEPHRINE-ACETAMINOPHEN PHENYLEPHRINE-ACETAMINOPHEN-GUAIFENESIN PHENYLEPHRINE-DIPHENHYDRAMINE-GUAIFENESIN- ACETAMINOPHEN PHENYLEPHRINE-GUAIFENESIN PHENYLEPHRINE-IBUPROFEN PHENYLTOLOXAMINE-ACETAMINOPHEN PLAN B ONE-STEP PRASTERA PREVACID PREVIDENT (DENTAL) PROBARIMIN QT PROBIOTIC PRODUCT (PACK) PROGESTERONE (INJ) PROGESTERONE (VAG) PROGESTERONE MICRONIZED PROMETHAZINE W/ CODEINE PROPECIA PRO-STAT MAX PRO-STAT RENAL CARE PRO-STAT SUGAR FREE PRO-STAT SUGAR FREE AWC (ADVANCED WOUND CARE) PRO-STAT SUGAR FREE AWC PROSTIN VR (INJ) (2) PROTEOLIN KPCO Commercial HMO Drug Exclusion List Page 7 of 9 Revision date: January 1, 2018

8 PSEUDOEPHEDRINE-ACETAMINOPHEN PSEUDOEPHEDRINE-GUAIFENESIN PSEUDOEPHEDRINE-IBUPROFEN PSEUDOEPHEDRINE-NAPROXEN SODIUM RABIES IMMUNE GLOBULIN (HUMAN) (INJ) RETISERT (IMPLANT) RHEUMATE RHO D IMMUNE GLOBULIN (HUMAN) (INJ) RHOFADE CREAM (TOPICAL) RIDUZONE ROSADAN KIT (TOPICAL) SCULPTRA (INJ) SENTRA AM SENTRA PM SEXUAL DYSFUNCTION DRUGS (ORAL/INJ) (2) SIBUTRAMINE HCL MONOHYDRATE (3) SILAZONE THP (TOPICAL) SILDENAFIL CITRATE (2) SILVER CARBOXYMETHYLCELLULOSE SOD/BANDAGES & RELATED PRODUCTS (SUPPLIES) SMARTRX GABA THPK (PACK) SMARTRX GABA-V THPK (PACK) SODIUM FLUORIDE (DENTAL) SODIUM FLUORIDE-POTASSIUM NITRATE (DENTAL) SPACER/AEROSOL HOLDING CHAMBERS (DEVICE) STAXYN (2) STENDRA (2) SUMATRIPTAN-NAPROXEN SODIUM SUPER SOLUBLE DUOCAL SUPPRELIN LA/VANTAS (KIT) SYNAGIS (INJ) TAZAROTENE (FACIAL WRINKLES) (TOPICAL) TEARS AGAIN HYDRATE TERBINAFINE-HYDROXYPROPYL CHITOSAN (KIT) TESTOSTERONE CYPIONATE (KIT) TESTOSTERONE PELLETS (IMPLANT) THERAMINE THROAT LOZENGES THYROTROPIN ALFA (INJ) TICASPRAY (NASAL) TIZANIDINE & LINIMENT (PACK) TOCILIZUMAB (INJ) TORADOL (INJ) TOXICOLOGY SALIVA COLLECTION (KIT) TOXOIDS (INJ) TOZAL TREPADONE TRETINOIN (FACIAL WRINKLES) (TOPICAL) TRETINOIN W/ CLEANSER & MOISTURIZER (KIT) TRETIN-X (KIT) TREXIMET TRIAMCINOLONE ACETONIDE (NASAL) TRIAMCINOLONE ACETONIDE-DIMETHICONE-SILICONE (KIT) KPCO Commercial HMO Drug Exclusion List Page 8 of 9 Revision date: January 1, 2018

9 TRIAMCINOLONE ACETONIDE-SILICONE (PACK) TRI-LUMA (TOPICAL) TRYPSIN, BALSAM PERU AND CASTOR OIL (TOPICAL) UREA (TOPICAL) UROFOLLITROPIN PURIFIED (INJ) UTI-STAT VACCINE/TOXOID COMBO (INJ) VACCINES (INJ) VANIQA (TOPICAL) VASCAZEN VASCULERA VASOLEX (TOPICAL) VAYACOG VAYARIN VERAMYST SUSP (NASAL) VIAGRA (2) VIMOVO VITRASERT (IMPLANT) VP-GSTN VP-PRECIP VSL#3 WHYTEDERM (KIT) WOUND DRESSINGS (SUPPLIES) XOLAIR (INJ) XYZAL YOSPRALA ZINC CITRATE-PHYTASE ZOLADEX (IMPLANT) VAYAROL KPCO Commercial HMO Drug Exclusion List Page 9 of 9 Revision date: January 1, 2018

10 NONDISCRIMINATION NOTICE Kaiser Foundation Health Plan of Colorado (Kaiser Health Plan) complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Kaiser Health Plan does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. We also: Provide no cost aids and services to people with disabilities to communicate effectively with us, such as: Qualified sign language interpreters Written information in other formats, such as large print, audio, and accessible electronic formats Provide no cost language services to people whose primary language is not English, such as: Qualified interpreters Information written in other languages If you need these services, call (TTY: 711) If you believe that Kaiser Health Plan has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance by mail at: Customer Experience Department, Attn: Kaiser Permanente Civil Rights Coordinator, 2500 South Havana, Aurora, CO 80014, or by phone at Member Services: You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at or by mail or phone at: U.S. Department of Health and Human Services, 200 Independence Avenue SW., Room 509F, HHH Building, Washington, DC 20201, , (TDD). Complaint forms are available at HELP IN YOUR LANGUAGE ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Call (TTY: 711). አማርኛ (Amharic) ማስታወሻ: የሚናገሩት ቋንቋ ኣማርኛ ከሆነ የትርጉም እርዳታ ድርጅቶች በነጻ ሊያግዝዎት ተዘጋጀተዋል ወደ ሚከተለው ቁጥር ይደውሉ (TTY: 711). العربية (Arabic) ملحوظة: إذا كنت تتحدث العربية فإن خدمات المساعدة اللغوية تتوافر لك بالمجان. اتصل برقم :TTY(.)711 Ɓa sɔ ɔ Wu ɖu (Bassa) Dè ɖɛ nìà kɛ dyéɖé gbo: Ɔ jǔ ké m Ɓàsɔ ɔ -wùɖù-po-nyɔ jǔ ní, nìí, à wuɖu kà kò ɖò po-poɔ ɓɛ ìn m gbo kpáa. Ɖá (TTY: 711) 中文 (Chinese) 注意 : 如果您使用繁體中文, 您可以免費獲得語言援助服務請致電 (TTY:711) _ACA_1557_MarCom_CO_2017_Taglines

11 فارسی (Farsi) توجه: اگر به زبان فارسی گفتگو می کنيد تسهيالت زبانی بصورت رايگان برای شما فراهم می باشد. با :TTY) 711) تماس بگيريد. Français (French) ATTENTION: Si vous parlez français, des services d'aide linguistique vous sont proposés gratuitement. Appelez le (TTY: 711). Deutsch (German) ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: (TTY: 711). Igbo (Igbo) NRỤBAMA: Ọ bụrụ na ị na asụ Igbo, ọrụ enyemaka asụsụ, n efu, dịịrị gị. Kpọọ (TTY: 711). 日本語 (Japanese) 注意事項 : 日本語を話される場合無料の言語支援をご利用いただけます (TTY: 711) までお電話にてご連絡ください 한국어 (Korean) 주의 : 한국어를사용하시는경우, 언어지원서비스를무료로이용하실수있습니다 (TTY: 711) 번으로전화해주십시오. Naabeehó (Navajo) Díí baa akó nínízin: Díí saad bee yáníłti go Diné Bizaad, saad bee áká ánída áwo dé é, t áá jiik eh, éí ná hóló, koji hódíílnih (TTY: 711). न प ल (Nepali) ध य न द न ह स : तप र इ ल न प ल ब ल न ह न छ भन तप र इ क ननम तत भ ष सह यत स व हर नन श ल क र पम उपलब ध छ )TTY: 711( फ न गन ह स Afaan Oromoo (Oromo) XIYYEEFFANNAA: Afaan dubbattu Oroomiffa, tajaajila gargaarsa afaanii, kanfaltiidhaan ala, ni argama. Bilbilaa (TTY: 711). Pусский (Russian) ВНИМАНИЕ: eсли вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните (TTY: 711). Español (Spanish) ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al (TTY: 711). Tagalog (Tagalog) PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa (TTY: 711). Tiếng Việt (Vietnamese) CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số (TTY: 711). Yorùbá (Yoruba) AKIYESI: Ti o ba nso ede Yoruba ofe ni iranlowo lori ede wa fun yin o. E pe ero ibanisoro yi (TTY: 711) _ACA_1557_MarCom_CO_2017_Taglines

Kaiser Permanente Commercial HMO Drug Exclusion List

Kaiser Permanente Commercial HMO Drug Exclusion List glumet Kaiser Permanente Cmmercial HMO Drug Exclusin List The fllwing is a list f drugs and drug entities that are excluded frm prescriptin benefit cverage. Prir authrizatin will nt apply. Kasier Permanente