General Guidelines - Resource Brokerage€¦ · 5’4 92-186 187-229 230-252 5’5 94-192 193-234 235-257 5’6 97-197 198-239 240-263 5’7 99-201 202-245 246-270 5’8 102-207 208-251

General GuidelinesOur goal in underwriting is to issue your LTCi business in a timely manner.

Underwriting long term care insurance requires attention to an applicant’s:

• current functional and cognitive ability

• current medical conditions including medications

An important component of successful long term care sales is thoroughfield underwriting. Please review the following guidelines.

Eligible issue ages 18-84 based on age nearest birthday.*

We consider applicants age nearest 85, but only prior to their 85thbirthday. Some state restrictions may apply.

FOR PRODUCER USE ONLY. NOT FOR USE WITH THE PUBLIC.

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Premium Rate ClassesSignatureCare offers three premium rate classes that you may quote:Ultra Preferred, Select Preferred and Preferred. Underwriting decisionswill depend on the multiplicity and severity of the medical conditionsalong with other factors. The final underwriting determination will bebased on the information that was reviewed for the applicant. It iscritical that you quote the appropriate rate class and in the event yourclient qualifies for a better rate than quoted, we will contact you todetermine whether to issue with a lower rate or increased benefits.MassMutual Financial Group LTCi underwriting has the full authority toissue coverage, modify coverage, or deny coverage based on bothmedical and non medical factors irrespective of the suggestedguidelines that are outlined in the Field Underwriting Guide.

Quoting:It is recommended to check each medical condition reported by theclient in the Field Underwriting Guide and not to quote the ultra-preferred rate if two or more ultra preferred conditions are disclosedsince certain conditions may represent greater risk. Since your clientmay be disappointed with a premium higher than you originally quoted,it is critical that you quote the appropriate rate class.

The following premium rate classes are offered:

• Ultra Preferred (85%)

• Select Preferred (100%)

• Preferred (125%)


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The following is a list of the classifications defined and some generalguidelines for determining qualification:

ULTRA PREFERRED (ALL MUST APPLY)For very healthy non-smoking applicants.

• Non-cigarette smoker for the last 12 months(other tobacco use acceptable)

• Weight is within Ultra Preferred range on Height/Weight Chart

• Consultation with a physician in the last 24 months

• Applicants with no medical history or considered to be undertreatment for a mild medical impairment

• No current treatment for a serious condition (such as heart orcirculatory disorder, diabetes, rheumatoid arthritis or cancer)

• Applicants may be receiving regular treatment of a preventativenature only, for example:

• Medication such as thyroid replacement, hormonalsupplements, digestive aids, or analgesics and anti-inflammatory medications that are used on an as neededbasis are acceptable.

• High blood pressure that is kept in the normal range (140/90to 120/80) with medication is acceptable, but cannot be incombination with other heart disorders.

SELECT PREFERRED (ONE OR MORE OF THE FOLLOWING APPLY)For individuals that are currently being treated for minimal to moderatemedical impairments or in combination but are considered to be stableand under adequate control.

• Cigarette Smoker with no other significant medical history andotherwise in good health

• Weight is within the Select Preferred range on Height/Weight Chart

• Medical history of cardiac or circulatory disorder, diabetes,rheumatoid arthritis, or cancer with excellent prognosis


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• Under regular treatment with prescription medications listed inthe Prescription Drug Guide for Conditions Not Eligible for UltraPreferred Rates.

• No medical consultation within the last 24 months

PREFERRED (ONE OR MORE OF THE FOLLOWING APPLY)For applicants with moderate to significant medical impairments due tohealth history, weight problems, smoking status or some combination ofthese factors but whose medical problems are well controlled andwhose overall health status is stable

• Under treatment for moderate to significant chronic healthcondition which requires close medical supervision (such asrheumatoid arthritis, ulcerative colitis, or emphysema)

• History of a combination of moderate to significant medicalimpairments (such as heart and lung disease, or rheumatoidarthritis with coronary artery disease)

• Weight is within the Preferred range on Height/Weight Chart

Additional Rate Classes used for Limited Benefit Offer Only: Thereare two additional rate classes available and will be offered to thoseapplicants who have a combination of medical conditions that pose ahigher, but not immediate risk, of utilization of long term care services.This is done at the underwriter’s discretion and only after allunderwriting requirements have been reviewed. Your underwriterwill call to discuss the offer.

Postpone: The medical condition has a specified stability period andmay be considered at a later date.

Uninsurable: The medical condition is not acceptable.

Previously Declined CasesIn general, individuals who have been previously declined for long termcare coverage are unlikely to qualify for coverage. Should an application besubmitted for an individual who has been declined previously, it is requiredthat a copy of the declination letter that provides the specific reason orreasons for the decline decision be submitted with the application.


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Height/Weight ChartThe height and weight charts are used for the purpose of assessingwhether a person has an increased risk of morbidity. The followingcharts set forth MassMutual’s guidelines for Males and for Females.Anyone outside the parameters listed on the following tables isconsidered a high risk for use of Long Term Care services and will beconsidered for coverage on an individual basis.

MALE BUILD CHART (WEIGHT IS IN POUNDS)

Height Ultra Preferred Select Preferred Preferred

5’0 92-186 187-214 215-235

5’1 94-190 191-217 218-239

5’2 96-194 195-222 223-244

5’3 99-201 202-227 228-250

5’4 102-206 207-232 233-255

5’5 104-209 210-238 239-262

5’6 107-217 218-244 245-268

5’7 110-222 223-250 251-275

5’8 113-229 230-257 258-283

5’9 116-234 235-264 265-290

5’10 119-240 241-271 272-298

5’11 122-246 247-278 279-306

6’0 125-254 255-288 289-317

6’1 128-259 260-292 293-321

6’2 129-267 268-299 300-329

6’3 135-274 275-307 308-338

6’4 139-282 283-315 316-347

6’5 143-288 289-323 324-355

6’6 147-297 298-331 332-364

6’7 151-306 307-339 340-373

6’8 155-314 315-347 348-382


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FEMALE BUILD CHART (WEIGHT IS IN POUNDS)

Height Ultra Preferred Select Preferred Preferred

4’8 78-157 158-191 192-210

4’9 79-160 161-195 196-215

4’10 80-163 164-199 200-219

4’11 82-166 167-203 204-223

5’0 84-170 171-208 209-229

5’1 86-174 175-213 214-234

5’2 88-178 179-218 219-240

5’3 90-184 185-223 224-245

5’4 92-186 187-229 230-252

5’5 94-192 193-234 235-257

5’6 97-197 198-239 240-263

5’7 99-201 202-245 246-270

5’8 102-207 208-251 252-276

5’9 105-212 213-257 258-283

5’10 108-218 219-264 265-290

5’11 111-225 226-272 273-299

6’0 115-232 233-282 283-310

6’1 118-240 241-292 293-321

6’2 121-247 248-300 301-330

6’3 124-254 255-309 310-340

6’4 127-260 261-318 319-350


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Medical Condition GuidelinesAAbscess – A localized collection of pus in any part of the body.

• resolved or 6 months after surgery . . . . . . . . .ULTRA PREFERRED

• brain or abdominal

• present or surgery within 6 months . . . . . . . .POSTPONE

Acoustic Neuroma – A benign tumor that may develop in the hearingand balance nerves in the inner ear.

• surgically removed . . . . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED

• present . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Addison’s Disease – A severe hormonal deficiency of the adrenal gland.

• well controlled on medication . . . . . . . . . . . .SELECT PREFERRED

Adhesions

• post surgery, full recovery . . . . . . . . . . . . . . . .ULTRA PREFERRED

ADL (Activities of Daily Living) Deficits

• any mental or physical limitation in performing theactivities of daily living . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Adult Day Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

AIDS (Acquired Immunodeficiency Syndrome) . . . . .UNINSURABLE

Alcoholism – A disease marked by excessive consumption of anddependence on alcoholic drinks.

• recovered more than 5 years, in good health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED

• recovered more than 3 years, in good health . . . . . . .PREFERRED

• within 3 years or with relapses . . . . . . . . . . . . . . .UNINSURABLE

Allergies and Hay Fever . . . . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED


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Alzheimer's Disease – The deterioration of intellectual functions.

• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Amaurosis Fugax – A temporary, partial, or complete loss of vision.

• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Amnesia – Memory loss, sometimes including the memory ofpersonal identity

• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Amputation – To cut off or remove usually through surgery a projectingbody part.

• due to trauma or congenital, independent,no ADL limitations . . . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED

• due to disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Amyotrophic Lateral Sclerosis (Lou Gehrig’s Disease) – The degeneration of muscular activity within the brain and thespinal cord.

• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Anemia – A deficiency of red blood cells in the blood.

• mild . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED

• moderate . . . . . . . . . . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED

• severe or with complications or defined as Aplastic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Aneurysm – Abnormal expansion of a blood vessel.

• abdominal or thoracic, 1 year after surgerywith good recovery . . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED

• cerebral, with or without surgery . . . . . . . . . . . . . .UNINSURABLE

• present or surgery within 1 year . . . . . . . . . . . . . . . . . .POSTPONE


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Angina Pectoris – Severe pain and constriction in region of the heart.

• controlled on medications . . . . . . . . . . . . . . . .SELECT PREFERRED

• occasional episodes, or with historyof myocardial infarction . . . . . . . . . . . . . . . . .SELECT PREFERRED

• with current (or within past 12 months)cigarette smoking . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Angioplasty, Cardiac – Repair of a blood vessel with a balloon orthrough a surgical procedure.

• after 6 months, with or without medication . .SELECT PREFERRED

• with stent, after 6 months, with orwithout medication . . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED

• with history of myocardial infarction . . . . . . .SELECT PREFERRED

• with current cigarette smoking, ongoing heart failure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Ankylosing Spondylitis – Chronic inflammation of the spine andsacroiliac joints.

• mild . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED

• moderate . . . . . . . . . . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED

• with narcotic use or physical limitations . . . . . . . .UNINSURABLE

Anxiety Disorder – A state of apprehension, uneasiness, and fear.

• situational with occasional medication . . . . . .ULTRA PREFERRED

• moderate with regular ormultiple medications . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED

• with hospitalization past 5 yearsor with functional impairment . . . . . . . . . . . . . . . .UNINSURABLE

Aplastic Anemia

• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE


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Arnold-Chiari Malformation – A genetic disorder occurring in thelower portion of the brain in the cerebellum or brainstem. Ultimatelyaffects balance, fine motor coordination, and unsteadiness in gait.

• Type 1 only, surgically repaired,after 5 years, no residuals . . . . . . . . . . . . . . .SELECT PREFERRED


Arrhythmias (other than Atrial Fibrillation) – Irregular heartbeat.

• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED

Arteriovenous Malformations (AVM) – An abnormal collection ofblood vessels.

• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Arteritis – Inflammation of an artery.

• currently being treated . . . . . . . . . . . . . . . . . . . . . . . . .POSTPONE

• off therapy more than 1 year, in remission . .SELECT PREFERRED

Arthritis (Degenerative or Osteoarthritis) – The breakdown anddeterioration of cartilage in the joints.

• mild, asymptomatic, no treatment oroccasional medication . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED

• moderate, with routine NSAID orjoint injections . . . . . . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED

• significant, taking multiple medications,no physical limitations . . . . . . . . . . . . . . . . . . . . . . . . .PREFERRED

• with physical limitations, multiple jointreplacements or surgery anticipated . . . . . . . . . . .UNINSURABLE


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Arthritis (Rheumatoid) – A chronic systemic disease marked byinflammatory changes in the joints.

• mild, controlled with non-steroidal medications,no deformities . . . . . . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED

• moderate to severe, requiringmultiple medications . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

• with physical limitations or surgery anticipated . .UNINSURABLE

Arthroscopy – Examination of or joint surgery using an arthroscope.

• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED

Asbestosis – A respiratory disease caused by inhaling asbestos fibersthat can lead to breathing problems and heart failure.

• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Assisted Living . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Asthma – A disease of the respiratory system characterized by difficultyof breathing.

• mild, seasonal, infrequent attacks withshort term medication use . . . . . . . . . . . . . . . .ULTRA PREFERRED

• moderate, controlled with medications(no steroids) . . . . . . . . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED

• severe, requiring multiple medications or steroids . . .PREFERRED


Atrial Fibrillation – A severe, chaotic irregular heartbeat, which couldlead to heart failure or strokes.

• new onset, < 6 months . . . . . . . . . . . . . . . . . . . . . . . . .POSTPONE

• history of, successful cardioversion,normal sinus rhythm . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED

• currently on anticoagulation medication . . . . . . . . . . .PREFERRED

• described as chronic, intermittent,or with multiple cardioversions . . . . . . . . . . . . . . .UNINSURABLE


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Attention Deficit Disorder (ADD) and Attention DeficitHyperactivity Disorder (ADHD) – A persistent pattern of inattentionand hyperactivity-impulsivity that occurs more frequently or severelythan is typical.

• stable, well controlled on single medication . .ULTRA PREFERRED

• stable on more than 1 medication . . . . . . . . .SELECT PREFERRED

Autoimmune Disorders – A person’s immune system begins to attackits own body, creating antibodies against its own tissue.

• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Avascular Necrosis – A disease resulting from loss of blood supply tothe bones causing death of bone tissue and bone collapse.

• mild, surgically corrected, . . . . . . . . . . . . . . . SELECT PREFERRED

BBack Pain

• mild, intermittent medication, nounderlying disease process . . . . . . . . . . . . . . .ULTRA PREFERRED

• due to herniated disc (unoperated) orspinal disorder . . . . . . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED

• surgery anticipated . . . . . . . . . . . . . . . . . . . . . . . . . . . .POSTPONE

Barrett’s Esophagus – A condition of the esophagus in which thenormal tissue changes into abnormal tissue caused by recurrent refluxof gastric juices.

• biopsy done within the last 2 yearswith favorable results . . . . . . . . . . . . . . . . . . .SELECT PREFERRED

Basal Cell Skin Cancer

• completely excised . . . . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED

Bell’s Palsy – Temporary paralysis of the facial muscles

• history of, complete recovery . . . . . . . . . . . . . .ULTRA PREFERRED


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Benign Prostatic Hypertrophy (BPH) – An enlargement of theprostate.

• PSA’s normal, controlled with medication,no surgery anticipated . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED

• with surgery and full recovery . . . . . . . . . . . . .ULTRA PREFERRED

Biliary Cirrhosis – A liver disease that slowly destroys the bile ducts inthe liver.

• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Bi-Polar Disorder – A mood disorder characterized by mood swingsfrom mania (exaggerated feeling of well-being) to depression

• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Bladder Infection – Urinary

• history of infection, complete recovery . . . . . .ULTRA PREFERRED

• chronic infections, without incontinence . . . .SELECT PREFERRED

Bladder Prolapse (Cystocele) – The dropping or sagging of a women’sbladder due to the weakness of the bladder.

• surgically repaired . . . . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED

Blood Pressure, Elevated – A higher than normal blood pressure.(check list for cardiac medications)

• mild and no other cardiac condition . . . . . . . . .ULTRA PREFERRED

• in combination with othercardiac condition . . . . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED

• poor medication compliance or not controlled . . . .UNINSURABLE

Brain Tumor – Abnormal growth in or on the brain

• after 5 years following removal,benign, no residuals . . . . . . . . . . . . . . . . . . . . . . . . . . .PREFERRED

• all others . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Breast Disorders – Any type of lump, swelling, cyst or mass that canbe felt in the breast tissue.

• fibrocystic disease . . . . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED


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Bronchiectasis – A chronic expansion and destruction of the bronchiof the lungs, with secondary infection.

• asymptomatic, non-cigarette smoker, minimum 1 year sincediagnosis, normal pulmonary function tests . . . . . . . .PREFERRED

• chronic, with hospitalizations . . . . . . . . . . . . . . . . .UNINSURABLE

Bronchitis – Acute or chronic inflammation of the bronchial tube.

• acute attack, nonsmoker . . . . . . . . . . . . . . . . . .ULTRA PREFERRED

• multiple attacks, smoker . . . . . . . . . . . . . . . . .SELECT PREFERRED

• chronic, nonsmoker . . . . . . . . . . . . . . . . . . . . . . . . . . . .PREFERRED

• chronic, with current (or within past 12 months)cigarette smoking . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Buerger’s Disease (Thromboangiitis Obliterans) – A chronic,recurring, inflammatory, vascular disease of the peripheral arteriesand veins.

• current . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

• full recovery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .PREFERRED

• chronic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Bypass Surgery (Heart) – A surgery that reroutes the blood supply bybypassing blocked arteries.

• after 6 months, with good results . . . . . . . . .SELECT PREFERRED

• with history of myocardial infarction . . . . . . .SELECT PREFERRED


CCancer – An uncontrolled growth of abnormal cells which havemutated from normal tissue.

Bladder

Early Stage 0 (in situ), 2 year fromlast treatment . . . . . . . . . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED


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Early Stages (A, B1, B2), 2 years fromlast treatment . . . . . . . . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED

Early stages (A, B1, B2), 5 years fromlast treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED

All other stages, over 2 years fromlast treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .PREFERRED

Any invasion of regional lymphatics, metastasis,or recurrence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Breast

Early Stage 0, 1, 2, over 2 years fromlast treatment . . . . . . . . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED

Early Stage 0,1,2, over 5 years fromlast treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED

Stages III, IV over 2 years from last treatment . . . . . . . .PREFERRED

Stages III, IV, over 5 years from last treatment .SELECT PREFERRED


Colon

Stages 0, I (Dukes A) 2 years fromlast treatment . . . . . . . . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED

Stages 0, I (Dukes A) 5 years fromlast treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED

Stages IIA, IIB (Dukes B), IIIA (Dukes C) 2 yearsfrom last treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . .PREFERRED

Stages IIA, IIB (Dukes B), IIIA (Dukes C) 5 yearsfrom last treatment . . . . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED



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Esophagus

Stage 0 (in situ), 5 years from last treatment . . . . . . . . .PREFERRED

Any invasion of regional lymphatics,metastasis, or recurrence . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Kidney

Stage I, II, 2 years from last treatment . . . . . . .SELECT PREFERRED

Stage I, II, 5 years from last treatment . . . . . . . .ULTRA PREFERRED

All other stages, over 2 years from last treatment . . . . .PREFERRED


Liver

All stages within 5 years . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

All stages 5 years from last treatment . . . . . . . . . . . . . .PREFERRED

Lung

All stages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Lymphoma

Stages I, II, 10 years from last treatment . . . . . . . . . . . .PREFERRED

Melanoma

Stage 0 (in situ), 1 year from last treatment . . . .ULTRA PREFERRED

Stages IA, IB, IIA, IIB, 2 years fromlast treatment . . . . . . . . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED

Stages IA, IB, IIA, IIB, 5 years fromlast treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED

Stage IIIA, 2 years from last treatment . . . . . . . . . . . . . .PREFERRED

Stage IIIA, 5 years from last treatment . . . . . . .SELECT PREFERRED



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Ovarian

Stages IA, IB, IC, 2 years from last treatment . .SELECT PREFERRED

Stages IA, IB, IC, 5 years from last treatment . . .ULTRA PREFERRED

Stage IIA, 2 years from last treatment . . . . . . . . . . . . . .PREFERRED

Stage IIA, 5 years from last treatment . . . . . . . .SELECT PREFERRED


Prostate

Grade 1, 2 years from last treatment . . . . . . . . .SELECT PREFERRED

Grade 1, 5 years from last treatment . . . . . . . . . .ULTRA PREFERRED

Grade 2-3, 2 years from last treatment . . . . . . . . . . . . . .PREFERRED

Grade 2-3, 5 years from last treatment . . . . . . ..SELECT PREFERRED

Any invasion of regional lymphatics, metastasis,

Or recurrence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Cane Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Cardiomyopathy – A disease that damages the heart muscle so that itloses its ability to pump blood and can cause irregular heartbeats.

• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Carotid Artery Disease – A constriction or narrowing of the arteriesthat supply the blood flow to the neck and brain.

• nonsmoker, asymptomatic or corrected by endarterectomy, nohistory of TIA or stroke . . . . . . . . . . . . . . . . . .SELECT PREFERRED

• nonsmoker, asymptomatic, with otherheart or circulatory disorder . . . . . . . . . . . . . . . . . . . . .PREFERRED

• severe; symptomatic or cigarette smoker . . . . . . .UNINSURABLE


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Carpal Tunnel Syndrome – A painful and progressive condition causedby compression of the median nerve.

• successful surgery, no residuals . . . . . . . . . . . .ULTRA PREFERRED

• surgery anticipated, with functional limits . . . . . . . . . .POSTPONE

Cataracts – A clouding of the lens or the eye, which obstructs thepassage of light.

• recovered after surgery . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED

• present but not requiring surgery,no visual impairment . . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED

• surgery scheduled or anticipated . . . . . . . . . . . . . . . . .POSTPONE

Catheter (current use; indwelling) A tubular medical device forinsertion into canals, vessels, or passageways to permit injection orwithdrawal of fluids.

• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Cerebral Palsy – A disorder of movement and gait caused by braindamage.

• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Cerebral Vascular Accident (CVA) – The blood supply to a part of thebrain is interrupted by an ischemic stroke or by a hemorrhagic stroke.

• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Charcot-Marie-Tooth Disease – A hereditary progressiveneuromuscular disorder that primarily affects the feet, leg, and hands.

• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Cholecystitis, Cholelithiasis (see Gallbladder) – A suddeninflammation of the gallbladder that causes severe pain.

Chronic Fatigue Syndrome – A prolonged persistent fatigue that canbe incapacitating and/or debilitating.

• mild, controlled with medication, not affectingfunctional ability . . . . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED

• with depression . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .PREFERRED


18

• severe, with functional limitations;use of steroids or narcotics . . . . . . . . . . . . . . . . . .UNINSURABLE

Chronic Obstructive Pulmonary Disease (COPD) – A severe diseaseof the lungs that obstructs the airways.

• nonsmoker, controlled with 1-2 medications/inhalers, nohospitalizations . . . . . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED

• nonsmoker, controlled with 1-2 medications, occasional steroiduse, no hospitalizations . . . . . . . . . . . . . . . . . . . . . . . .PREFERRED

• with current (or within past 12 months) cigarette smoking,oxygen use, hospitalizations, daily steroid use, with heartor circulatory disorders . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Cirrhosis, Liver – The gradual loss of liver function due to cell damageand internal scarring.

• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Cognitive Impairment – The inability to mentally function normally,reduction in memory, thinking, and learning.

• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Colitis – A chronic, episodic, inflammatory disease of the large intestineand rectum characterized by bloody diarrhea.

• controlled with medication . . . . . . . . . . . . . . .SELECT PREFERRED

• occasional flares, treated with steroids,normal weight . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .PREFERRED

• recurrent flares, hospitalizations, weight loss,chronic steroids . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Collagen Vascular Disease – Any disorder affecting the connectivetissue, with rheumatic symptoms including muscle stiffness, soreness,and pain in the joints.

• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Colostomy – An opening of a portion of the colon through theabdominal wall.

• 2 years after surgery, no complications . . . . .SELECT PREFERRED


19

Confusion

• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Congestive Heart Failure (CHF) – The heart’s inability to maintainsufficient cardiac output to meet the body’s needs.

• controlled with medications for 1 year, singleevent, ejection fraction >45% . . . . . . . . . . . . . . . . . . .PREFERRED

• chronic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Connective Tissue Disease (see Collagen Vascular Disease)

Coronary Artery Disease – A condition that reduces the blood flowthrough the coronary arteries to the heart muscle.

• with angina or positive cardiac test . . . . . . . .SELECT PREFERRED

• with history of myocardialinfarction or angioplasty . . . . . . . . . . . . . . . . .SELECT PREFERRED

• with current (or within past 12 months)cigarette smoking, or multiple heart attacks . . . . .UNINSURABLE

CREST Syndrome (see Scleroderma)

Crohn’s Disease – Inflammation and ulceration of the small intestine.


• occasional flares, treated with steroids,normal weight . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .PREFERRED

• recurrent flares, hospitalizations, weight loss,chronic steroids . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Cushing’s Syndrome (due to Pituitary, Adrenal or Ectopic Tumors)– A hormonal disorder resulting from the overproduction ofcorticosteroid by the adrenal gland.

• corrected by surgery, no complications or secondarydisorders such as high blood pressure, osteoporosisor diabetes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .PREFERRED



20

CVA (see Stroke)

Cystic Fibrosis – An inherited disease characterized by chronic lunginfections and an inability to absorb fats or other nutrients from foods.

• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Cystitis – Inflammation of the urinary bladder.

• acute . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED

DDegenerative Joint Disease (see Arthritis)

Dementia – A cognitive deficit including memory impairment.

• all forms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Demyelinating Disease – Causing or characterized by the loss ordestruction of myelin (the sheath around nerve fibers), such asmultiple sclerosis.

• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Depression – A mental disorder marked by sadness, inactivity, difficultywith thinking and concentration, feelings of helplessness andworthlessness.

• mild, situational or treated with occasional, regular, or multiplemedication . . . . . . . . . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED

• chronic with multiple medications, hospitalizationsUNINSURABLE

Dermatomyositis – An autoimmune disorder in which the muscles andskin become inflamed, causing weakness of the muscles and a skin rash.

• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Diabetes Mellitus, Insulin Dependent – A chronic disease ofcarbohydrate metabolism in which the body makes little or no insulin,requiring daily injections of insulin to sustain life.

• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Diabetes Mellitus, Non-Insulin Dependent (diet or oralmedications) – A chronic disease of carbohydrate metabolism, markedby high blood sugar and sugar in urine, resulting from inadequate


21

production or use of insulin.

• newly diagnosed or change in medications < 1 year . .POSTPONE

• diet or oral medication control . . . . . . . . . . . .SELECT PREFERRED

• diet or medication control, overweight, . . . . . . . . . . . .PREFERRED

• poor control or with other serious health conditions, diabeticcomplications, cigarette smoker or smoker within past12 months . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Dialysis, Kidney – A procedure to remove the waste products from theblood and excess fluid from the body as a treatment for kidney failure.

• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Diverticulitis, Diverticulosis (see Irritable Bowel Syndrome) –Diverticulitis is inflammation and perforation of a diverticulum (anabnormal pouch or sac of the intestine), Diverticulosis is a conditionwhere small sacs of the inner lining of the intestine are present.

Down’s Syndrome – A chromosome abnormality resulting in moderateto severe mental retardation and other abnormalities

• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Drug Dependency or Abuse

• after 5 years, complete abstinenceincluding alcohol . . . . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED

• after 3 years, complete abstinenceincluding alcohol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .PREFERRED

• within 3 years or with relapses . . . . . . . . . . . . . . .UNINSURABLE

Duodenal Ulcer – A peptic ulcer situated in the small intestines.

• history of, occasional medication . . . . . . . . . . .ULTRA PREFERRED

• chronic, frequent flare ups and/or bleeding . .SELECT PREFERRED

• surgery anticipated or scheduled . . . . . . . . . . . . . . . . .POSTPONE

Dupuytren’s Contracture – A painless thickening and contracture oftissue beneath the skin on the palm of the hand.

• present or surgically corrected, no functional


22

limitations or other disease present . . . . . . . .ULTRA PREFERRED


EEmphysema (see Chronic Obstructive Pulmonary Disease)

Endarterectomy (see Carotid Artery Disease) – surgery to remove orbypass fatty deposits or blockage in an artery.

Endocarditis – Inflammation of the inner lining of the heart.

• fully recovered > 6 months, 1 episode,no residuals . . . . . . . . . . . . . . . . . . . . . . . . . . . .SELECT REFERRED

• recurrent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Epilepsy (Seizures) – Transient neurological abnormalities caused byabnormal electric activity in the brain.

• controlled on medication,seizure free > 12 months . . . . . . . . . . . . . . . . .SELECT PREFERRED

• seizure within 1 year; poorcontrol or cause unknown . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Epstein-Barr Syndrome – A herpes virus that causes infectiousmononucleosis.

• 6 months after full recovery, no residuals . . . .ULTRA PREFERRED

• current evaluation or work up . . . . . . . . . . . . . . . . . . . .POSTPONE

Esophageal Varices – Twisted, expanded areas in the esophagealveins resulting from portal hypertension caused by advanced liverdisease.

• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Esophagitis – Inflammation of the esophagus.

• mild, well controlled by diet or medication . . .ULTRA PREFERRED

• recurrent or with bleeding . . . . . . . . . . . . . . .SELECT PREFERRED


23

FFalls

• multiple (3) with or without injury in past 5 years .UNINSURABLE

Fatty Liver – Accumulation of excess fat in the liver cells. Some causesare obesity, high triglycerides and alcohol use.

• liver function tests normal, stable . . . . . . . . .SELECT PREFERRED

• abnormal liver function tests or relatedto alcohol intake . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Fibrocystic Breast Disease – A benign breast lump characterized bycysts and thickening of the milk glands.

• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED

Fibromyalgia – A chronic disorder of the muscles and related softtissue including ligaments and tendons, characterized by muscle pain,fatigue, and sleep disturbances.

• mild, controlled with minimal medication,no limitations . . . . . . . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED

• with chronic fatigue, weakness, functional limitations;use of steroids or narcotics . . . . . . . . . . . . . . . . . .UNINSURABLE

Fractures

• arm, due to trauma, no functional impairment,full recovery . . . . . . . . . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED

• leg, due to trauma, no functional impairment,full recovery . . . . . . . . . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED

• pelvis, due to trauma,no functional impairment . . . . . . . . . . . . . . . .SELECT PREFERRED

• Vertebral, due to trauma,no functional limits . . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED

• Vertebral, due to osteoporosis . . . . . . . . . . . . . . . .UNINSURABLE

• Paget’s disease . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE


24

Fuch’s Corneal Dystrophy – A gradual deterioration of one layer oranother of the cornea, which causes clouding and blurred vision.

• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

GGallbladder (Cholecystitis, Cholelithiasis) – A sudden inflammationof the gallbladder that causes severe pain.

• medically managed . . . . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED

• after 3 months surgery . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED

• pending or anticipated surgery . . . . . . . . . . . . . . . . . . .POSTPONE

Gastric Bypass Surgery (Stapling, Banding) – Surgery to promoteweight loss by reducing the size of the stomach and/or interrupting thedigestive process.

• after 6 months, must use weight attime of surgery . . . . . . . . . . . . . . . . . . . . . . . . . .SEE BUILD CHART

• after 24 months, use current weight . . . . . . . . . . . . . . . . . .CHART

Gastroesophageal Reflux Disease (GERD) – Regurgitation of gastricjuices into the lower esophagus.

• well controlled by diet or medication . . . . . . .ULTRA PREFERRED

• recurrent symptoms or flare ups . . . . . . . . . . .SELECT PREFERRED

Gilbert’s Disease (confirmed diagnosis) – An inherited disorder thataffects the way bilirubin is processed by the liver.

• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED

Glaucoma – A group of eye diseases that cause damage to the opticnerve which lead to blindness.

• treated with eyes drops,no visual impairment . . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED

• with progressive visual loss . . . . . . . . . . . . . . . . . .UNINSURABLE

Goiter – An enlargement of the thyroid gland.

• post surgery or post radioactive iodine treatment, benign,on thyroid replacement . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED


25

Gout – Recurrent inflammation of the peripheral joints, which maybecome chronic and cause joint deformity.

• controlled with medication, no flare up . . . . . .ULTRA PREFERRED

• with recurrent flare ups, . . . . . . . . . . . . . . . . .SELECT PREFERRED

Graves’ Disease – An autoimmune disease that causes over activity ofthe thyroid gland.

• controlled by medication . . . . . . . . . . . . . . . . .ULTRA PREFERRED

Guillian-Barre Syndrome – A disorder in which the body’s immunesystem attacks the peripheral nerves, which are outside the brain andspinal cord.

• full recovery after 12 months, no residuals or functionallimitations . . . . . . . . . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED

• full recovery with minimal residuals after 12 months, nofunctional limitations . . . . . . . . . . . . . . . . . . . . . . . . . .PREFERRED

HHashimoto’s Thyroiditis – An inflammation of the thyroid gland, thatfrequently results in hypothyroidism (low thyroid).

• controlled by thyroid replacement therapy . . .ULTRA PREFERRED

Headaches – Diffuse pain in different portions of the head, notconfined to any nerve distribution area.

• occasional medication . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED

Heart Attack – Insufficient blood supply to the heart muscle.

• after 6 months, single attack, 1-2 medications, stable and fullyfunctional . . . . . . . . . . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED

• after 12 months, second or multiple attacks, 1-2 medications,stable, fully functional . . . . . . . . . . . . . . . . . . . . . . . . .PREFERRED

• with chronic angina (chest pain) . . . . . . . . . . . . . . . . .PREFERRED

• current cigarette smoker or smokerwithin past 12 months . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE


26

Heart Blocks – A condition in which the signal from the heart’s upperto lower chambers is impaired or doesn’t transmit.

• left bundle branch block with normalstress test, echo . . . . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED

• right bundle branch block with normalstress test, echo . . . . . . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED

• First-degree AV Block, asymptomatic, treatment free,no underlying cardiac conditions . . . . . . . . . . .ULTRA PREFERRED

• Second-degree AV Block, asymptomatic, no underlyingcardiac conditions . . . . . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED

• Third-degree AV Block, asymptomatic, medicallytreated or with successful pacemaker implant, withknown heart disease, after 12 months . . . . . . . . . . . .PREFERRED

Heart Valve Disease with Replacement – A surgery used to repair orreplace diseased heart valves.

• after 6 months . . . . . . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED

• surgery scheduled or anticipated . . . . . . . . . . . . . . . . .POSTPONE

Hemochromatosis/Hemosiderosis – A disorder that causes the bodyto absorb excess iron, which accumulates in the liver, pancreas, heart,and in other organs.

• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Hemophilia – An inherited disorder in which a person’s blood lacks acertain protein important in forming blood clots, leading to excessivebleeding.

• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Hemorrhoids – A mass of dilated veins in swollen tissue at the marginof the anus or nearby within the rectum. Also known as piles.

• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED


27

Hepatitis (A & B) – An inflammation of the liver caused by viruses,bacteria, parasites, and toxic reactions to drugs, alcohol, and chemicals.

• hepatitis A, full recovery (3 months), normal liverfunction tests . . . . . . . . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED

• hepatitis B, full recovery (12 months), normal liverfunction tests . . . . . . . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED

• described as active, chronic active, ordue to alcohol . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Hepatitis C - The most serious hepatitis virus and the leading cause of chronic hepatitis, end stage liver disease, liver cancer and livertransplants in the US. The C virus is transmitted primarily by blood orblood products. Typically due to IV transfusion, past organ transplant,illegal drug use, or occupationally (health care workers who have hadaccidental needle sticks with infected blood).

• acute infection, after 1 year, considered recovered(virus cleared), no virus detectable, no illegaldrug use history, normal liver biopsy andnormal liver function tests . . . . . . . . . . . . . . .SELECT PREFERRED


Herniated Disc – A rupture of an intervertebral disc of the spine with aprotrusion of the disc’s core into the spinal canal.

• post surgery with good recovery . . . . . . . . . . .ULTRA PREFERRED

• present, no surgery planned . . . . . . . . . . . . . .SELECT PREFERRED


Hiatal Hernia – A portion of the stomach protrudes upward into thechest through an opening in the diaphragm.

• with or without surgery, controlled bydiet or medication . . . . . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED

Hip Replacement (see Joint Replacement)


28

HIV Positive

• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Hodgkin’s Lymphoma – A malignant growth of cells in thelymph system

• after 10 years, complete remission . . . . . . . . . . . . . . .PREFERRED

Home Care Service

• within the last 12 months . . . . . . . . . . . . . . . . . . . . . . .POSTPONE

Huntington’s Chorea – A genetic disease that involves thedegeneration of the basal ganglia of the brain.

• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Hydrocephalus – A disorder characterized by an excessive amount ofcerebrospinal fluid under pressure within the skull.

• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Hypercholesterolemia (high cholesterol) . . . . . .ULTRA PREFERRED

Hyperglycemia – a condition in which an excessive amount of sugarcirculates in the blood.


Hyperparathyroidism – The over activity of the parathyroid glandsthat leads to an abnormally elevated level of calcium in the blood.

• surgically corrected, normal calcium,no limitations . . . . . . . . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED

• minimally elevated calcium levels, stable, closely monitored, norelated disorders such as high blood pressure, impaired renalfunction, or bone demineralization . . . . . . . . .SELECT PREFERRED

Hypertension (see Blood Pressure, elevated)

Hyperthyroidism – The over activity of the thyroid gland which resultsin the over production of thyroid hormone.

• controlled with medication . . . . . . . . . . . . . . . .ULTRA PREFERRED

Hypothyroidism – The under activity of the thyroid gland which resultsin the under production of thyroid hormone.


29

• controlled with medication . . . . . . . . . . . . . . . .ULTRA PREFERRED

Hysterectomy – the surgical removal of the uterus.

• after 3 months, no complicationsor malignancy . . . . . . . . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED

IIleostomy (see Colostomy) – The creation of a surgical passagethrough the abdominal wall into the ileum.

Incontinence, Bowel – The inability of the body to control theevacuative functions.

• surgically corrected . . . . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED


Incontinence, Urinary – The inability of the body to control theevacuative functions.

• stress or urge, treated with 1 medication . . . .ULTRA PREFERRED

• treated with surgery, full recovery . . . . . . . . . .ULTRA PREFERRED

• complete loss of control . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Intestinal Obstruction – A partial or complete blockage of the bowelthat results in the failure of the intestinal contents to pass through.

• surgically corrected after 12 months,no residuals . . . . . . . . . . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED


Irritable Bowel Syndrome – A form of colitis, which is characterizedby constipation and diarrhea.

• controlled with medication,no surgery anticipated . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED

• frequent flare ups and/or bleeding . . . . . . . . .SELECT PREFERRED

ITP (Idiopathic Thrombocytopenic Purpura) – A bleeding disorderthat is caused by too few platelets in the blood.

• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE


30

JJoint Replacement (Knee or Hip) – The replacement of a joint.

• one or both joints, after 6 months,no functional limitations, . . . . . . . . . . . . . . . .SELECT PREFERRED


KKidney Dialysis (see Dialysis) – The build up of waste and toxins,which are not filtered out of the blood and start to accumulate inthe tissues.

Kidney Failure – Failure of the kidney to perform its essential functions.

• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Kidney Infection – An infection of the kidney and the ducts that carryurine away from the kidney.

• no current treatment, fully recovered . . . . . . . .ULTRA PREFERRED

• currently under treatment,medically managed . . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED

Kidney Stones (Nephrolithiasis) – renal calculi or nephrolithisis.Solid lump made up of crystals that separate from the urine.

• no current treatment, resolved . . . . . . . . . . . . .ULTRA PREFERRED

Kidney Transplant – A surgical procedure to implant a healthy kidneyinto a patient with kidney failure.

• 5 years after transplant, normal renal function tests,no complications . . . . . . . . . . . . . . . . . . . .PREFERRED (No HCBS)

Knee Replacement (see Joint Replacement) – The replacement ofa knee


31

LLabyrinthitis – An inflammation of the fluid filled chambers in the innerear that sense balance, resulting in vertigo.

• well controlled with occasional medication . .ULTRA PREFERRED

• well controlled on 1-2 medications . . . . . . . .SELECT PREFERRED

Lacunar Infarct (see Stroke) – An area of tissue in the brain thatundergoes death of cells following the cessation of blood supply,resulting from occlusion or stenosis of the supplying artery.

Lambert-Eaton Syndrome (Myasthenia Syndrome) – A conditionmarked by neuropathy and weakness of the limbs.

• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Left bundle branch block (see Heart Blocks) – A defect in thehearts electrical conduction system.

Leukemia (any type) – A group of bone marrow cancers in whichwhite blood cells divide uncontrollably, affecting the production ofnormal white blood cells, red blood cells and platelets.

• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Liver Cyst

• 1-2 cysts, no liver disease . . . . . . . . . . . . . . . .ULTRA PREFERRED

• multiple cysts, no kidney or liver disease . . . .SELECT PREFERRED

Lou Gehrig’s Disease (see Amyotrophic Lateral Sclerosis) – Thedegeneration of muscular activity within the brain and the spinal cord.

Lung Cancer (see Cancer)

Lupus (Discoid) – A chronic disease of the skin characterized byremissions and exacerbation of a scaling, red, macular rash.

• stable after 12 months, negative ANA . . . . . .ULTRA PREFERRED

Lupus Erythematosus (Systemic) – A chronic, inflammatory autoimmune disorder that may affect organ systems including the skin,joints, and internal organs.

• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE


32

Lyme’s Disease – A bacterium that is transmitted by a tick andcharacterized by skin changes, flu like symptoms and joint inflammation.

• correct diagnosis, adequate treatment,no residual, after 3 months . . . . . . . . . . . . . . .ULTRA PREFERRED

• correct diagnosis, adequate treatment,with residuals but full recovery . . . . . . . . . . .SELECT PREFERRED

• questionable diagnosis or current treatment . . . . . . . .POSTPONE

Lymphoma (see Cancer) – A form of cancer a malignant tumor of thelymphoid tissue.

MMacular Degeneration – A deterioration of the central portion of theretina, affecting central vision and visualization of fine details.

• no functional limits, successful adaptationto any visual loss . . . . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED

• progressive visual loss, changes to lifestyleto accommodate vision loss . . . . . . . . . . . . . . . . . .UNINSURABLE

Major Depression – An emotional state characterized by feelings ofpersistent sadness, worthlessness, rejection, loss of hope, and loss ofinterest in usual activities.

• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Manic Depression (see Bipolar)

Marfan’s Syndrome – An inheritable disorder of connective tissue thataffects the skeletal system, cardiovascular system, eyes, and skin.

• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Medicaid Recipient

• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Melanoma (see Cancer) – A malignant skin tumor containingdark pigment.


33

Memory Loss/Problems – A loss of the ability to memorizeinformation or recall information stored in the brain.

• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Meniere’s Disease – An inner ear disorder, usually accompanied byvarying degrees of hearing loss, ringing in the ears, and dizziness.

• adequately diagnosed by MRI, controlled with occasionalmedication, after 6 months . . . . . . . . . . . . . . .ULTRA PREFERRED

• diagnosis made by symptoms only, not diagnosed by MRI, regularmedication, after 6 months . . . . . . . . . . . . . . .SELECT PREFERRED

• uncontrolled with ongoing symptoms . . . . . . . . . .UNINSURABLE

Menopausal Symptoms (Pre/Post)

• adequately diagnosed, controlled with 1 depression medication inlieu of hormone replacement therapy . . . . . . .ULTRA PREFERRED

Mental Retardation – A condition characterized by impairedintellectual function which interferes with the ability to cope in everydayactivities.

• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Migraine Headaches – A severe, sometimes incapacitating headache,which can be accompanied by visual changes or stomach disturbances.

• uncomplicated, controlled withoccasional medication . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED

• described as complicated,uncontrolled orwith chronic pain and limitations . . . . . . . . . . . . . .UNINSURABLE

Mitral Valve Prolapse – A condition, in which the mitral valve in theheart is deformed, causing a degree of leakage and is characterized by aheart murmur and sometimes chest pain.

• no symptoms, normal EKG, may or may nottake antibiotic for prophylactic reasons . . . . . .ULTRA PREFERRED

• symptomatic or with other heart condition . .SELECT PREFERRED


34

Monoclonal Gammopathy – A disorder of the blood in which most ofthe protein produced is from one antibody instead of from many.

• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Multiple Myeloma – a malignancy of plasma cells derived from B-lymphocytes.

• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Multiple Sclerosis – A progressive disease of the central nervoussystem in which the protective covering of nerve fibers in the brain orspinal cord is destroyed.

• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Muscular Dystrophy – A slow, progressive disease characterized bydegeneration of muscle fibers.

• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Myasthenia Gravis – An autoimmune disorder in which the musclesbecome weak and tire easily.

• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Myasthenia Syndrome (see Lambert-Eaton Syndrome)

Myocardial Infarction (see Heart Attack) – Insufficient blood supplyto the heart muscle.

Myocarditis – An inflammation of the heart muscle, which is due to aviral infection.

• acute, full recovery, not related to any otherhealth condition . . . . . . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED

NNarcolepsy – A rare syndrome of recurrent attacks of sleep, suddenloss of muscle tone and sleep paralysis.

• well controlled, no functional limitations . . . .SELECT PREFERRED

• with disability or hospitalizations . . . . . . . . . . . . . .UNINSURABLE


35

Nephrectomy (removal of one kidney only)

• after 6 months, normal labs andkidney tests . . . . . . . . . . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED

• due to disease or unhealthy remaining kidney . . .UNINSURABLE

Nephrolithiasis (see Kidney Stones)

Nephrosclerosis – A kidney disorder in which the smallest arteries inthe kidneys are damaged.

• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Neurofibromatosis – A genetic disorder of the nervous system thatcauses tumors to form on the nerves anywhere in the body at any time.

• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Neurogenic Bladder – A urinary problem in which there is abnormalemptying of the bladder with subsequent retention or incontinence ofurine.

• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Neuropathy – An abnormal and degenerative state of the nervoussystem or nerves.

• mild, non progressive, no functional limitations . . . . .PREFERRED

• Progressive symptoms OR Requires adaptive devices orassistance with Activities, OR History of Falls OR Balanceproblem when walking OR under current evaluation

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Nursing Home Confinement

• within the last year . . . . . . . . . . . . . . . . . . . . . . . . . . . .POSTPONE

0Obsessive compulsive disorder (OCD) – A disorder characterized byrepetitive thoughts and behaviors.

• well controlled with goodongoing treatment . . . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED


36

Organ Transplant (except Kidney) – The replacement of a diseasedorgan with a healthy one.

• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Organic Brain Syndrome – A disturbance of mental functioning due toa physical cause as opposed to a psychological cause.

• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Osteomyelitis – An acute or chronic bone infection caused by bacteria.

• acute with complete recoveryafter 6 months . . . . . . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED

• chronic or active or with functional limitations . . .UNINSURABLE

Osteoporosis – A reduction of bone mass, causing bones to becomebrittle, fragile, and susceptible to fractures.

• mild, on medication, no history of fracture . .SELECT PREFERRED

• with fracture history . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Oxygen

• current use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

PPacemaker – An electrical device that can control the beating of theheart by a series of rhythmic electrical discharges.

• no complications . . . . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED

Paget’s Disease – A disruption of normal bone formation causing theaffected bones to weaken, thicken, and become deformed.

• if discovered on x-ray, no symptomsor fractures . . . . . . . . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED

• with fracture history . . . . . . . . . . . . . . . . . . . . . . . . . . .PREFERRED

• with severe joint deformity or pain . . . . . . . . . . . .UNINSURABLE


37

Panic Disorder – Panic disorder is characterized by recurrent panicattacks (i.e., periods of intense fear and discomfort) on anunpredictable basis.

• medication as needed . . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED

• routine or daily medication taken . . . . . . . . . .SELECT PREFERRED

• with prior hospitalization(s) or disability . . . . . . . .UNINSURABLE

Pancreatitis – An inflammation of the pancreas.

• single episode, no residual, completerecovery after 6 months . . . . . . . . . . . . . . . . . .ULTRA PREFERRED

• Chronic or with multiple episodes ordue to alcohol . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Paralysis (all forms) – A complete or partial loss of controlledmovement caused by an inability to contract one or more muscles.

• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Parkinson’s Disease – A chronic progressive nervous disease markedby tremor, muscular weakness, rigidity and peculiar gait.

• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Pericarditis – A disorder caused by inflammation of the pericardium,which is the sac like covering of the heart.

• acute, full recovery, no other cardiac orrelated health condition . . . . . . . . . . . . . . . . . .ULTRA PREFERRED

Peripheral Neuropathy – A disease or degenerative state of theperipheral nerves marked by muscle weakness, atrophy, pain andnumbness.

• if caused by nerve root compression . . . . . . . . . . . . . .PREFERRED

• if caused by disease . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE


38

Peripheral Vascular Disease – A disease of the blood vesselscharacterized by narrowing and hardening of the arteries that supply thelegs and feet, causing a decrease in blood flow that can injure nervesand other tissues.

• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Phlebitis – Painful inflammation of a vein.

• single attack, fully recoveredafter 3 months . . . . . . . . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED

Physical Therapy

• within the last 6 months . . . . . . . . . . . . . . . . . . . . . . . .POSTPONE

Pick’s Disease – A rare degenerative brain illness that causesdementia and is marked by progressive impairment of intellectand judgment.

• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Pituitary Tumor, benign (see Brain tumor)

Polio – A virus which invades the central nervous system marked bytremor, muscle pain, muscle weakness, stiffness, serious breathingproblems, or death.

• history of, with full function,no past paralysis . . . . . . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED

• history of paralysis, now with full function . .SELECT PREFERRED

• with post polio syndrome or withcurrent residual paralysis . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Polycystic Kidney Disease – An inherited disease characterized bythe growth of numerous cysts filled with fluid in the kidneys.

• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Polycythemia – A blood disease with abnormal increase in red andwhite blood cells and platelets.

• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE


39

Polymyalgia Rheumatica – An inflammatory syndrome, which ismarked by pain and stiffness in the muscles of the hips, thighs,shoulders and neck.

• No symptoms and controlled with medication,in remission, No ongoing steroid use,No functional limits . . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED

• controlled with low dose steroid medications . . . . . . .PREFERRED

• with symptoms, frequent narcotic use,with functional limitations . . . . . . . . . . . . . . . . . . .UNINSURABLE

Polyps – A tumor, which is commonly found in vascular organs such asthe nose, uterus, colon, and rectum.

• surgically removed, benign . . . . . . . . . . . . . . . .ULTRA PREFERRED

• malignant . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .See Cancer

Post Traumatic Stress disorder – A psychiatric disorder that canoccur following a traumatic experience, a life threatening, or extremelydistressing situation that causes a person to feel intense fear, horror ora sense of helplessness.

• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Prostate Cancer (see Cancer)

Prostate Enlargement

• benign prostate hypertrophy (BPH), withor without surgery . . . . . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED

PSA (Elevated) (Prostate-Specific Antigen) – An enzyme that isproduced by the prostate gland that can be measured in the blood.

• Elevated, proven benign by biopsy, BPH treatedwith 1 medication or no medications . . . . . . . .ULTRA PREFERRED

• if rising, not within normal limits for age ornot proven benign . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

• elevated, no biopsy done, monitoring . . . . . . . . . . . . . .POSTPONE


40

Psoriatic Arthritis – Pain and swelling of joints with patches of scalyskin related to psoriasis.

• no functional limits, no joint deformities, treatedwith 1 medication (not steroids) . . . . . . . . . . .SELECT PREFERRED

• moderate impairment, no functional limits, treated withsteroids, Methotrexate, Embrel, Plaquenil or similar medications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .PREFERRED

• severe joint deformity, ongoing pain, treated withnarcotics, with functional limitations . . . . . . . . . . .UNINSURABLE

Psychosis – A severe mental disorder in which the individual losescontact with reality.

• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Pulmonary Embolism – A blockage in an artery in the lungs caused bya blood clot that travels through the blood vessels to the lungs.

• one occurrence, no complications,off all blood thinners . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED

• recurrent, multiple . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Pulmonary Fibrosis – Scarring or thickening of tissues deep in the lungusually resulting from previous lung inflammation such as pneumonia, ortuberculosis.

• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

RRaynaud’s Disease – A disorder of the small blood vessels of theextremities, is characterized by intermittent pallor, blanching andcoldness of the affected parts.

• mild, non-progressive, with orwithout medications . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED

• progressive or with functional limitations . . . . . . .UNINSURABLE


41

Raynaud’s Phenomenon – A circulatory disorder with similar signsand symptoms of Raynaud’s disease.


• due to serious underlying disease . . . . . . . . . . . . .UNINSURABLE

Reflex Sympathetic Dystrophy – A chronic pain condition that is theresult of dysfunction in the central or peripheral nervous system.

• Current, mild degree of impairment,no functional limitations . . . . . . . . . . . . . . . . .SELECT PREFERRED

Renal Failure – A gradual and progressive loss of the ability of thekidneys to excrete waste, concentrate urine, and conserve electrolytes.

• current . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

• acute, after 1 year, fully recovered,no residuals . . . . . . . . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED

• chronic renal insufficiency . . . . . . . . . . . . . . . . . . . . . .PREFERRED

Renal Insufficiency (not chronic) – Insufficient excretion of wastesby the kidneys.

• after 12 months, stable . . . . . . . . . . . . . . . . . .SELECT PREFERRED

Restless Leg Syndrome – A neurological disorder characterized byunpleasant sensations in the legs and an uncontrollable desire tomove them.

• controlled on one medication . . . . . . . . . . . . .SELECT PREFERRED

• multiple medications or use ofanti-Parkinson’s medications . . . . . . . . . . . . . . . . . . . .PREFERRED

Retinal Artery Occlusion – A blockage of the main artery leading tothe retina or one of it’s branches.

• after 2 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .PREFERRED

• within 2 years or multiple episodes . . . . . . . . . . . .UNINSURABLE

Retinitis Pigmentosa – A condition characterized by a degeneration ofthe rods and cones of the retina of the eye, which leads to blindness.

• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE


42

Retinopathy (Diabetic) – A disease of the retina due to diabetes thatcan cause decreased vision and blindness.

• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Rheumatoid Arthritis (see Arthritis) – A chronic systemic diseasemarked by inflammatory changes in the joints.

SSarcoidosis – A chronic multisystem disease of unknown causecharacterized by inflammatory cells, called granulomas that can producemany different symptoms.

• no progression for at least 1 year, mild symptoms,no treatment, non-cigarette smoker . . . . . . . .SELECT PREFERRED

• with current (or within past 12 months) cigarettesmoking or progressive . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Schizophrenia – A mental disorder that makes it difficult to tell thedifference between real and imagined experiences, to think logically, orto behave appropriately in social situations.

• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Scleroderma (Crest Syndrome) – An autoimmune disorder of theconnective tissue, which is characterized by formation of scar tissue inthe skin and organs of the body.

• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Scoliosis – A crookedness or lateral curvature of the spine.

• mild, no functional limitations . . . . . . . . . . . . .ULTRA PREFERRED

• severe but without physical limitations . . . . .SELECT PREFERRED

Seizure Disorder (see Epilepsy)

Self-Reported Memory Concerns

• current or within 5 years . . . . . . . . . . . . . . . . . . . . .UNINSURABLE


43

Shunts (Brain, Heart or Kidney) – A normal or abnormal passage bywhich bodily fluid is diverted from one channel, circulatory path, or partto another.

• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Shy-Drager Syndrome – A degenerative disease characterized byprogressive damage to the autonomic nervous system, muscle tremor,rigidity, and slow movement.

• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Sickle Cell Anemia – A hereditary disorder in which the red bloodcells contain an abnormal hemoglobin (protein carried by red cells),which results in blood cells shaped like sickles.

• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Sjogren’s Syndrome – A chronic disease in which white blood cellsattack the moisture producing glands, but it is a systemic disease,affecting many organs and may cause fatigue.

• mild, no limitations . . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED

• with disability or physical limitations . . . . . . . . . . .UNINSURABLE

Skin Cancer (not Melanoma) – Cancer that may arise on the surfaceof the body and form a small ulcer or pimple.

• external, basal or squamous cell cancer . . . . .ULTRA PREFERRED

Sleep Apnea – A breathing disorder characterized by brief interruptionsof breathing during sleep.

• Operated, Complete Recovery, No cardiac disease,Nonsmoker . . . . . . . . . . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED

• mild or currently using CPAP . . . . . . . . . . . . . .SELECT PREFERRED

• with cardiac disorder and/or overweight . . . . . . . . . . .PREFERRED

Smoking Cigarettes

• without medical problems . . . . . . . . . . . . . . . . . . .SELECT PREFERRED

• with chronic upper respiratory infections . . . . . . . . . . . . . .PREFERRED

• with diabetes, heart or lung disease . . . . . . . . . . . . . . .UNINSURABLE


44

7Spinal Stenosis – A narrowing of the space in the spinal canalthrough which nerves run.

• mild, non-progressive . . . . . . . . . . . . . . . . . . .SELECT PREFERRED

• mild, multiple medications required,no functional limitations . . . . . . . . . . . . . . . . . . . . . . . .PREFERRED

Splenectomy – Surgical removal of the spleen due to traumaor disease.

• fully recovered . . . . . . . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED

Stent (cardiac) – A short or narrow metal plastic tube that isinserted into an artery or bile duct to keep a previously blockedpassageway open.

• after 6 months, with good results . . . . . . . . .SELECT PREFERRED

Stroke – A loss of brain functions caused by a loss of blood circulationto areas of the brain.

• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Subarachnoid Hemorrhage – A disorder in which blood from aruptured blood vessel spreads over the surface of the brain.

• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Subclavian Steal Syndrome – A condition characterized by recurrentattacks of blurred or double vision, dizziness and loss of coordinationcaused by reduced blood flow to the base of the brain.

• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Subdural Hematoma – A collection of blood between the surface ofthe brain and its outer covering.

• within 2 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .POSTPONE

• after 2 years, no residuals . . . . . . . . . . . . . . .SELECT PREFERRED

Suicide Attempt – The unsuccessful act of ending one’s own life.

• all . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Surgery Anticipated . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .POSTPONE


45

TTemporal Arteritis – A chronic inflammation of large arteries, typicallyof the temporal artery, an artery on the side of the scalp.

• 1 year after recovery . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED

• in remission, currently taking Prednisoneor other steroid medication . . . . . . . . . . . . . . . . . . . . .PREFERRED

Temporomandibular Joint Syndrome (TMJ) – A dysfunction oralteration of the temporomandibular joint, which is the joint that allowsjaw mobility.

• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ULTRA PREFERRED

Thrombocythemia (elevated blood platelets) . . . . . .UNINSURABLE

Thrombocytopenic Purpura (low blood platelets) . .UNINSURABLE

TIA (Transient Ischemic Attack) – A brief interruption of the bloodsupply to a part of the brain.

• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Transverse Myelitis – A rare neurological disorder characterized byinflammation of the spinal cord.

• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Tremors – Involuntary movements in the muscles of the hands, arms,and head but can affect the legs.

• Benign, Essential, Intention or Familial, Must bestable for 6 months with no progression and normalneurological Exam . . . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED

U - ZUlcers (Duodenal or Peptic) – An erosion of the inner lining of thestomach usually caused by gastric acid and pepsin.

• history of, occasional medication . . . . . . . . . . .ULTRA PREFERRED

• chronic, frequent flare ups and/or bleeding . .SELECT PREFERRED

• surgery scheduled . . . . . . . . . . . . . . . . . . . . . . . . . . . . .POSTPONE


46

Varicose Veins – Enlarged, twisted, painful superficial veins resultingfrom poorly functioning valves.

• uncomplicated, without medication . . . . . . . . .ULTRA PREFERRED

• medication required or with skin ulcers . . . . .SELECT PREFERRED

• with FUNCTIONAL LIMITATIONS or other complications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Vertebral Basilar Insufficiency – A condition in which blood flow tothe vertebral arteries is restricted or insufficient.

• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Vertigo – A type of dizziness that is characterized by the sensationof spinning.


• not controlled . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Von Willebrand’s Disease – An inherited disorder of the blood, whichleads to abnormal bleeding.

• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Waldenstrom’s Disease – Excessive production of red blood cells,white blood cells, and platelets in the bone marrow.

• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Wilson’s Disease – An inherited disorder in which excessive amountsof copper accumulate in the body.

• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNINSURABLE

Wolf-Parkinson-White Syndrome – An abnormal heart rhythmcausing increased heart rate.

• asymptomatic, no medication, and/or successfully treated byradiofrequency ablation . . . . . . . . . . . . . . . . . .ULTRA PREFERRED

• episodes of tachycardia or treatedwith medication . . . . . . . . . . . . . . . . . . . . . . . .SELECT PREFERRED


47

AA.

Z.T.

Azid

othy

mid

ine

HIV

Infe

ctio

nAn

tiret

rovir

alNo

t Ins

urab

leAb

ilify

Depr

essio

nAn

ti Ps

ycho

ticNo

t Ins

urab

leAc

amro

sate

Alco

holis

mNo

t Ins

urab

leAc

cola

teZa

firlu

kast

Resp

irato

ryAn

tiast

hmat

ic, B

ronc

hodi

lato

rOt

her t

han

Ultra

Accu

Neb

Albu

tero

lRe

spira

tory

Bron

chod

ilato

rOt

her t

han

Ultra

Accu

pril

Quin

april

Card

iac

Antih

yper

tens

iveUs

ually

Ultr

aAc

curb

ron

Theo

phyll

ine

Resp

irato

ryBr

onch

odila

tor

Othe

r tha

n Ul

traAc

tiqFe

ntan

ylNa

rcot

ic Pa

in M

edica

tion

Opio

id A

nalg

esic

Not I

nsur

able

Acto

nel

Rise

dron

ate

Oste

opor

osis,

Pag

et’s

Bone

Res

orpt

ion

Inhi

bito

rOt

her t

han

Ultra

Acto

sPi

oglit

azon

e(N

IDDM

)An

tidia

betic

Othe

r tha

n Ul

traAc

tron

Keto

prof

enAr

thrit

is, P

ain

NSAI

DOt

her t

han

Ultra

Acyc

lovir

Acyc

lovir

Herp

es In

fect

ions

Antiv

iral

Usua

lly U

ltra

Adal

atNi

fedi

pine

Card

iac-

Calci

um C

hann

el B

lock

erAn

tiang

inal

, Ant

ihpe

rtens

ives

Othe

r tha

n Ul

traAd

enoc

ard

Aden

osin

eCa

rdia

cAn

tiarrh

ythm

icOt

her t

han

Ultra

Adde

rall

Atte

ntio

n De

ficit

Diso

rder

Usua

lly U

ltra

Adria

myc

inDo

xoru

bicin

Hyd

roch

lorid

eCa

ncer

Antin

eopl

astic

Not I

nsur

able

Adva

irFlu

ticas

one/

Salm

eter

ol C

ombo

Resp

irato

ryOt

her t

han

Ultra

Advil

Ibup

rofe

nAr

thrit

is, P

ain

NSAI

DOt

her t

han

Ultra

Aero

bid-

M In

hale

rFlu

niso

lide

Inha

ler

Resp

irato

ry In

hale

rCo

rtico

rste

roid

Inha

ler,

Antia

sthm

atic

Othe

r tha

n Ul

traAg

ener

ase

HIV

Not I

nsur

able

Aggr

enox

ASA/

Dipy

rimad

ole

Cicu

latio

nAn

tipla

tele

t Age

ntOt

her t

han

Ultra

Agry

linTh

rom

bocy

tope

nia

Not I

nsur

able

FOR

PROD

UCER

USE

ON

LY. N

OT F

OR U

SE W

ITH

THE

PUBL

IC.

48

500

Serie

s Pr

escr

iptio

n Dr

ug G

uide

Drug

-Gen

eric

Ge

neric

Nam

eDe

scrip

tion/

Ther

apeu

tic C

lass

Prob

able

Act

ion

& T

rade

Nam

esCo

nditi

ons

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ted

A-hy

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Cort

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tison

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dAn

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ic, C

ortic

oste

roid

Othe

r tha

n Ul

traAi

ret

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tero

lRe

spira

tory

Bron

chod

ilato

rOt

her t

han

Ultra

Akin

eton

Bipe

riden

Park

inso

n‚An

tipar

kinso

nNo

t Ins

urab

leAl

bute

rol

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tero

lRe

spira

tory

Bron

chod

ilato

rOt

her t

han

Ultra

Alca

rDe

men

tiaNo

t Ins

urab

leAl

dact

azid

ee

Com

boCa

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c, Ed

ema

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ually

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ually

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iac

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ually

Ultr

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ne R

esor

ptio

n In

hibi

tors

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r tha

n Ul

traAl

eve

Napr

oxen

Arth

ritis,

Pai

nNS

AID

Othe

r tha

n Ul

traAl

kera

nCa

ncer

Antin

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astic

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nsur

able

Allo

purin

olAl

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rinol

Gout

Antig

out A

gent

Usua

lly U

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ar H

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lly U

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iac

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ually

Ultr

aAl

upen

tM

etap

rote

reno

lRe

spira

tory

Inha

ler

Bron

chod

ilato

rOt

her t

han

Ultra

Aman

tadi

neAm

anta

dine

Park

inso

n, V

iral I

nfec

tions

Antip

arkin

son,

Ant

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lNo

t Ins

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leAm

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de(N

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tidia

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r tha

n Ul

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pill

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tive/

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lly U

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rtTr

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cinol

one

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oid

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sthm

atic,

Cor

ticos

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idOt

her t

han

Ultra

Amer

geNa

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rain

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scul

ar H

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ant

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etha

pred

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hylp

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neSt

eroi

dAn

tiast

hmat

ic, C

ortic

oste

roid

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r tha

n Ul

traAm

etho

pter

inM

etho

trexa

teRh

eum

atoi

d Ar

thrit

isDM

ARD,

Imm

unos

uppr

essa

ntOt

her t

han

Ultra

Amin

ophy

lline

Amin

ophy

lline

Resp

irato

ryBr

onch

odila

tor

Othe

r tha

n Ul

traAm

ioda

rone

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daro

neCa

rdia

cAn

tiarrh

ythm

icsOt

her t

han

Ultra

Amitr

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line

Amitr

ipty

line

Depr

essio

n, C

hron

ic Pa

inAn

tidep

ress

ant

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r tha

n Ul

tra

FOR

PROD

UCER

USE

ON

LY. N

OT F

OR U

SE W

ITH

THE

PUBL

IC.

49

Drug

-Gen

eric

Ge

neric

Nam

eDe

scrip

tion/

Ther

apeu

tic C

lass

Prob

able

Act

ion

& T

rade

Nam

esCo

nditi

ons

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ted

Amlo

dipi

neAm

lodi

pine

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iac-

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um C

hann

el B

lock

erAn

tihyp

erte

nsive

Usua

lly U

ltra

Anaf

lex

Salsa

late

Arth

ritis,

Pai

nNS

AID

Othe

r tha

n Ul

traAn

afra

nil

Clom

ipra

min

eDe

pres

sion

Antio

bses

sive

Agen

tOt

her t

han

Ultra

Anak

inra

Anak

inra

Rheu

mat

oid

Arth

ritis

DMAR

DOt

her t

han

Ultra

Anap

rox

Napr

oxen

Arth

ritis,

Pai

nNS

AID

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r tha

n Ul

traAn

aspa

zHy

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amin

eUr

inar

y, Ga

stro

inte

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smod

ic, A

ntich

olin

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cUs

ually

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aAn

astra

zole

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trazo

leBr

east

Can

cer

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eopl

astic

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r tha

n Ul

traAn

exsia

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one/

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amin

ophe

nNa

rcot

ic Pa

in M

edica

tion

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id A

nalg

esic

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nsur

able

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idFlu

rbip

rofe

nAr

thrit

isNS

AID,

Ant

irheu

mat

icOt

her t

han

Ultra

Anta

buse

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holis

mNo

t Ins

urab

leAn

tiver

tM

ecliz

ine

Mot

ion

Sick

ness

, Ver

tigo

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met

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ines

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r tha

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traAp

o-Flu

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rofe

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rbip

rofe

nAr

thrit

isNS

AID,

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irheu

mat

icOt

her t

han

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son’s

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Park

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n’sNo

t Ins

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leAp

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legi

line

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son

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arkin

son

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nsur

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Vera

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rapa

mil

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iac-

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um C

hann

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lock

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, Vas

cula

r Hea

dach

esOt

her t

han

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solin

eHy

dral

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cAn

tihyp

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r tha

n Ul

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viral

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nsur

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esp

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ia o

f Chr

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icNo

t Ins

urab

leAr

ava

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nom

ide

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mat

oid

Arth

ritis

DMAR

DOt

her t

han

Ultra

Ared

iaPa

mid

rona

teHy

perc

alce

mia

, Pag

et’s

Bone

Res

orpt

ion

Inhi

bito

rOt

her t

han

Ultra

Arice

ptDo

nepe

zilM

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y Lo

ssAn

ti-Al

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nsur

able

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trazo

leBr

east

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cer

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astic

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r tha

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traAr

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ort

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hmat

ic, C

ortic

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roid

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r tha

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roid

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oid

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one

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t Ins

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leAr

thro

pan

Chol

ine

Salic

ylate

Arth

ritis

NSAI

DOt

her t

han

Ultra

FOR

PROD

UCER

USE

ON

LY. N

OT F

OR U

SE W

ITH

THE

PUBL

IC.

50

Drug

-Gen

eric

Ge

neric

Nam

eDe

scrip

tion/

Ther

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tic C

lass

Prob

able

Act

ion

& T

rade

Nam

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nditi

ons

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ted

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rote

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clofe

nac/

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pros

tol C

ombo

Arth

ritis

NSAI

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ith A

ntiu

lcer A

gent

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r tha

n Ul

traAr

ticul

ose

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niso

lone

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oid

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sthm

atic,

Cor

ticos

tero

idOt

her t

han

Ultra

Asac

olM

esal

amin

eGa

stro

inte

stin

al-U

lcera

tive

Colit

isGI

Ant

iinfla

mm

ator

yOt

her t

han

Ultra

Asce

ndin

Amox

apin

eDe

pres

sion

Antid

epre

ssan

tOt

her t

han

Ultra

Asm

alix

Theo

phyll

ine

Resp

irato

ryBr

onch

odila

tor

Othe

r tha

n Ul

traAs

para

gina

seCa

ncer

Leuk

emia

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nsur

able

Asth

maH

aler

Mist

Epin

ephr

ine

Resp

irato

ryVa

sopr

esso

rsOt

her t

han

Ultra

Astra

mor

phM

orph

ine

Narc

otic

Pain

Med

icatio

nOp

ioid

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icNo

t Ins

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arta

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epPa

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nNo

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ine

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ually

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her t

han

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ic, C

ortic

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roid

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hole

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at)-L

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drug

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tol

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amaz

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ural

gia

Antic

onvu

lsant

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r tha

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traAt

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HIV

Antir

etro

viral

Not I

nsur

able

Atro

vent

Ipra

tropi

umRe

spira

tory

Inha

ler

Bron

chod

ilato

rOt

her t

han

Ultra

Aura

nofin

Gold

The

rapy

Arth

ritis

Othe

r tha

n Ul

traAv

andi

aRo

siglit

azon

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tidia

betic

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n Ul

traAv

apro

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arta

nHy

perte

nsio

nAn

tihyp

erte

nsive

Usua

lly U

ltra

Avas

tinCa

ncer

Canc

erOt

her t

han

Ultra

Aven

tyl

Nortr

ipty

line

Depr

essio

nAn

tidep

ress

ant

Othe

r tha

n Ul

traAv

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Mul

tiple

Scle

rosis

Mul

tiple

Scle

rosis

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nsur

able

Axer

tAl

mot

ripta

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igra

ines

Vasc

ular

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dach

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ually

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le S

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sisM

ultip

le S

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leAz

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is, C

rohn

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mun

osup

pres

sant

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r tha

n Ul

tra

FOR

PROD

UCER

USE

ON

LY. N

OT F

OR U

SE W

ITH

THE

PUBL

IC.

51

Drug

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eric

Ge

neric

Nam

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scrip

tion/

Ther

apeu

tic C

lass

Prob

able

Act

ion

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rade

Nam

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nditi

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Trea

ted

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mid

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mid

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HIV

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ctio

nAn

tiret

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alNo

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urab

leAz

mac

ort

Tria

mcin

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e In

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rRe

spira

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Inha

ler

Corti

cors

tero

id In

hale

r, An

tiast

hmat

icOt

her t

han

Ultra

Azul

fidin

eSu

lfasa

lazin

eRh

eum

atoi

d Ar

thrit

is, C

rohn

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mat

ory

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tiret

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past

icity

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phen

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etal

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ler

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atic

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opa

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ti Pa

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son

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cyclo

min

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stro

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ic, C

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roid

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r tha

n Ul

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c-Be

ta B

lock

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tiarrh

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her t

han

Ultra

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sero

nM

ultip

le S

clero

sisM

ultip

le S

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sisNo

t Ins

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leBe

than

ecol

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olUr

inar

y-Bl

adde

rUr

inar

y Tr

act S

timul

ant

Usua

lly U

ltra

Bext

raVa

ldec

oxib

Arth

ritis,

Pai

nNS

AID

Othe

r tha

n Ul

traBi

perid

enBi

perid

enPa

rkin

son

Antip

arkin

son

Not I

nsur

able

Blen

oxan

eCa

ncer

Canc

erNo

t Ins

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leBl

ocod

ren

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olCa

rdia

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ma,

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oma

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ion

Sick

ness

, Ver

tigo

Antie

met

ics, A

ntih

istam

ines

Othe

r tha

n Ul

traBo

niva

Oste

opor

osis

Oste

opor

osis

Othe

r tha

n Ul

traBo

tox

Cosm

etic

surg

ery,

Dysk

ines

iaUs

ually

Ultr

aBr

etha

ireTe

rbut

alin

eRe

spira

tory

Inha

ler

Bron

chod

ilato

rOt

her t

han

Ultra

Brev

iblo

cEs

mol

olCa

rdia

c-Be

ta B

lock

erAn

tiarrh

ythm

icOt

her t

han

Ultra

FOR

PROD

UCER

USE

ON

LY. N

OT F

OR U

SE W

ITH

THE

PUBL

IC.

52

Drug

-Gen

eric

Ge

neric

Nam

eDe

scrip

tion/

Ther

apeu

tic C

lass

Prob

able

Act

ion

& T

rade

Nam

esCo

nditi

ons

Trea

ted

Bria

cany

lRe

spira

tory

Resp

irato

ryOt

her t

han

Ultra

Brom

ocrip

tine

Park

inso

n’sPa

rkin

son’s

Dise

ase

Not I

nsur

able

Brov

ana

Resp

irato

ryRe

spira

tory

Othe

r tha

n Ul

traBu

deso

nide

Inha

ler

Bude

soni

de In

hale

rRe

spira

tory

Inha

ler

Corti

cors

tero

id In

hale

r, An

tiast

hmat

icOt

her t

han

Ultra

Bulsu

fan

Canc

erCa

ncer

Not I

nsur

able

Bum

exBu

met

anid

eEd

ema

Othe

r tha

n Ul

traBu

prop

ion

Bupr

opio

nDe

pres

sion,

Sm

okin

g Ce

ssat

ion

Anitd

epre

ssan

t, Sm

okin

g De

terra

ntOt

her t

han

Ultra

BuSp

arBu

spiro

neAn

xiety

Antia

nxie

tyOt

her t

han

Ultra

Byet

taDi

abet

esAn

ti di

abet

icOt

her t

han

Ultra

CCa

ferg

otEr

gota

min

e/Ca

ffein

e Co

mbo

Mig

rain

esVa

scul

ar H

eada

che

Supp

ress

ant

Usua

lly U

ltra

Cala

n SR

Vera

pam

ilCa

rdia

c-Ca

lcium

Cha

nnel

Blo

cker

Antih

yper

tens

ive, V

ascu

lar H

eada

ches

Othe

r tha

n Ul

traCa

lcito

nin

Calci

toni

nOs

teop

oros

is, P

aget

’sHy

poca

lcem

icOt

her t

han

Ultra

Cam

pral

Alco

holis

mAl

coho

lism

Not I

nsur

able

Capo

ten

Capt

opril

Card

iac

Antih

yper

tens

iveUs

ually

Ultr

aCa

psai

cinCa

psai

cinPa

in M

anag

emen

t, To

pica

lNo

nopi

oid

Anal

gesic

s (To

pica

l)Ot

her t

han

Ultra

Capt

opril

Capt

opril

Card

iac

Antih

yper

tens

iveUs

ually

Ultr

aCa

rafa

teSu

cral

fate

Gast

roin

test

inal

Antiu

lcer A

gent

Usua

lly U

ltra

Carb

acot

Met

hoca

rbam

olM

uscle

Spa

sms

Skel

etal

Mus

cle R

elax

ant

Othe

r tha

n Ul

traCa

rbam

azep

ine

Carb

amaz

epin

eNe

ural

gia

Antic

onvu

lsant

Othe

r tha

n Ul

traCa

rbat

rol

Carb

amaz

epin

eNe

ural

gia

Antic

onvu

lsant

Othe

r tha

n Ul

traCa

rbex

Sele

gilin

ePa

rkin

son

Antip

arkin

son

Not I

nsur

able

Carb

idop

aPa

rkin

son’s

Park

inso

n’s D

iseas

eNo

t Ins

urab

leCa

rden

eNi

card

ipin

eCa

rdia

c-Ca

lcium

Cha

nnel

Blo

cker

Antia

ngin

al, A

ntih

perte

nsive

sOt

her t

han

Ultra

Card

izem

Dilti

azem

Card

iac-

Calci

um C

hann

el B

lock

erAn

tihpe

rtens

ives

Usua

lly U

ltra

Card

ura

Doxa

zosin

Card

iac

Antih

yper

tens

iveUs

ually

Ultr

a

FOR

PROD

UCER

USE

ON

LY. N

OT F

OR U

SE W

ITH

THE

PUBL

IC.

53

Drug

-Gen

eric

Ge

neric

Nam

eDe

scrip

tion/

Ther

apeu

tic C

lass

Prob

able

Act

ion

& T

rade

Nam

esCo

nditi

ons

Trea

ted

Caris

opro

dol

Caris

opro

dol

Mus

cle S

pasm

sSk

elet

al M

uscle

Rel

axan

tOt

her t

han

Ultra

Carti

aXT

Dilti

azem

Card

iac-

Calci

um C

hann

el B

lock

erAn

tihpe

rtens

ives

Usua

lly U

ltra

Caso

dex

Canc

erAn

tineo

plas

ticNo

t Ins

urab

leCa

tafla

mDe

clofe

nac

Arth

ritis

NSAI

DOt

her t

han

Ultra

Cata

pres

Clon

idin

eCa

rdia

cAn

tihyp

erte

nsive

Usua

lly U

ltra

Cee

NuCa

ncer

Canc

erNo

t Ins

urab

leCe

lebr

exCe

leco

xibAr

thrit

isNS

AID,

Ant

irheu

mat

icOt

her t

han

Ultra

Cele

ston

eBe

tam

etha

sone

Ster

oid

Antia

sthm

atic,

Cor

ticos

tero

idOt

her t

han

Ultra

Cele

xaCi

talo

pram

Depr

essio

nAn

tidep

ress

ant

Othe

r tha

n Ul

traCe

lont

inCe

rebr

al A

rtery

Dise

ase

Not I

nsur

able

Ceph

ulac

Lact

ulos

eGa

stro

inte

stin

al-C

onst

ipat

ion

Laxa

tive

Usua

lly U

ltra

Ceru

bidi

neCa

ncer

Not I

nsur

able

Cevim

elin

eCe

vimel

ine

Sjog

ren’s

Syn

drom

eCh

olin

ergi

cOt

her t

han

Ultra

Chan

tixSm

okin

g Ce

ssat

ion

Othe

r tha

n Ul

traCh

lora

l Hyd

rate

Chlo

ral H

ydra

teSe

dativ

eSe

dativ

e/Hy

pono

ticOt

her t

han

Ultra

Chlo

ram

bucil

Chlo

ram

bucil

Canc

erAn

tineo

plas

tic, I

mm

unos

uppr

essa

ntNo

t Ins

urab

leCh

lord

iaze

poxid

eCh

lord

iaze

poxid

eAn

xiety

-Ben

zodi

azep

ine

Antia

nxie

ty, S

edat

ive/H

ypno

ticOt

her t

han

Ultra

Chlo

roth

iazid

eCh

loro

thia

zide

Card

iac,

Edem

aAn

tihyp

erte

nsive

, Diu

retic

Usua

lly U

ltra

Chlo

rpro

maz

ine

Chlo

rpro

maz

ine

Psyc

hose

sAn

tipsy

chot

ics, A

ntie

met

icNo

t Ins

urab

leCh

lorp

ropa

mid

eDi

abet

esAn

tidia

bete

sOt

her t

han

Ultra

Chlo

rthal

idon

eCh

lorth

alid

one

Card

iac,

Edem

aAn

tihyp

erte

nsive

, Diu

retic

Usua

lly U

ltra

Chol

esty

ram

ine

Chol

esty

ram

ine

Hype

rcho

lest

erol

emia

Lipid

-(fat

)-Low

erin

g dr

ugUs

ually

Ultr

aCh

olin

e Sa

licyla

teCh

olin

e Sa

licyla

teAr

thrit

isNS

AID

Othe

r tha

n Ul

traCh

ronu

lac

Lact

ulos

eGa

stro

inte

stin

al-C

onst

ipat

ion

Laxa

tive

Usua

lly U

ltra

Cilo

staz

olCi

lost

azol

Circ

ulat

ion

Antip

late

let A

gent

Not I

nsur

able

Cim

etid

ine

Cim

etid

ine

Gast

roin

test

inal

Antiu

lcer A

gent

Usua

lly U

ltra

Cin-

Quin

Quin

idin

e Su

lfate

Card

iac

Antia

rryth

mics

Othe

r tha

n Ul

traCi

spla

tinCa

ncer

Not I

nsur

able

FOR

PROD

UCER

USE

ON

LY. N

OT F

OR U

SE W

ITH

THE

PUBL

IC.

54

Drug

-Gen

eric

Ge

neric

Nam

eDe

scrip

tion/

Ther

apeu

tic C

lass

Prob

able

Act

ion

& T

rade

Nam

esCo

nditi

ons

Trea

ted

Clad

ribin

eLe

ukem

ia, M

ultip

le S

clero

sisAn

ti ne

opla

stic

Not I

nsur

able

Clar

inex

Deslo

rata

dine

Alle

rgie

s, Hi

ves

Antih

istam

ine

Usua

lly U

ltra

Clin

oril

Sulin

dac

Arth

ritis,

Pai

nNS

AID,

Ant

irheu

mat

icOt

her t

han

Ultra

Clon

azep

amCl

onaz

epam

Seizu

re D

isord

erAn

ticon

vulsa

ntOt

her t

han

Ultra

Clon

idin

eCl

onid

ine

Card

iac

Antih

yper

tens

iveUs

ually

Ultr

aCl

oraz

ilDe

pres

sion

Anti

psyc

hotic

Not I

nsur

able

Cloz

apin

eCl

ozap

ine

Schi

zoph

reni

aAn

tipsy

chot

icNo

t Ins

urab

leCo

dein

eCo

dein

eNa

rcot

ic Pa

in M

edica

tion

Opio

id A

nalg

esic

Call

Coge

ntin

Benz

tropi

nePa

rkin

son

Antip

arkin

son

Not I

nsur

able

Cogn

exTa

crin

eM

emor

y Lo

ssAn

ti-Al

zhei

rmer

Not I

nsur

able

Cola

zal

Balsa

lazid

eGa

stro

inte

stin

al: U

lcera

tive

Colit

isGI

Ant

iinfla

mm

ator

yUs

ually

Ultr

aCo

lchici

neCo

lchici

neGo

utAn

tigou

t Age

ntUs

ually

Ultr

aCo

lese

vela

mCo

lese

vela

mHy

perc

hole

ster

olem

iaLip

id-(f

at)-L

ower

ing

drug

Usua

lly U

ltra

Cole

stid

Cole

stip

olHy

perc

hole

ster

olem

iaLip

id-(f

at)-L

ower

ing

drug

Usua

lly U

ltra

Com

bipr

esCh

lorth

alid

one/

Clon

idin

e Co

mbo

Card

iac

Antih

yper

tens

iveUs

ually

Ultr

aCo

mbi

vent

Com

boRe

spira

tory

Inha

ler

Bron

chod

ilato

rOt

her t

han

Ultra

Com

pazin

ePr

ochl

orpe

razin

ePs

ycho

ses

Antie

met

ic, A

ntip

sych

otic

Not I

nsur

able

Com

tan

Enta

capo

nePa

rkin

son

Antip

arkin

son

Not I

nsur

able

Conc

erta

Atte

ntio

n De

ficit

Diso

rder

CNS

Stim

ulan

tUs

ually

Ultr

aCo

paxo

neM

ultip

le S

clero

sisim

mun

omod

ulto

rNo

t Ins

urab

leCo

rdro

lPr

edni

sone

Ster

oid

Antia

sthm

atic,

Cor

ticos

tero

idOt

her t

han

Ultra

Core

gCa

rved

ilol

Card

iac-

Bet

a Bl

ocke

rAn

tihyp

erte

nsive

Usua

lly U

ltra

Corg

ard

Nado

lol

Card

iac

Antia

ngin

al, A

ntih

yper

tens

iveOt

her t

han

Ultra

Corte

fHy

droc

ortis

one

Ster

oid

Antia

sthm

atic,

Cor

ticos

tero

idOt

her t

han

Ultra

Corti

sone

Corti

sone

Ster

oid

Antia

sthm

atic,

Cor

ticos

tero

idOt

her t

han

Ultra

Corto

neCo

rtiso

neSt

eroi

dAn

tiast

hmat

ic, C

ortic

oste

roid

Othe

r tha

n Ul

traCo

rver

tIb

utili

deCa

rdia

cAn

tiarrh

ythm

icsOt

her t

han

Ultra

Corzi

deCo

mbo

Card

iac

Antia

ngin

al, A

ntih

yper

tens

iveOt

her t

han

Ultra

FOR

PROD

UCER

USE

ON

LY. N

OT F

OR U

SE W

ITH

THE

PUBL

IC.

55

Drug

-Gen

eric

Ge

neric

Nam

eDe

scrip

tion/

Ther

apeu

tic C

lass

Prob

able

Act

ion

& T

rade

Nam

esCo

nditi

ons

Trea

ted

Coto

lone

Pred

niso

lone

Ster

oid

Antia

sthm

atic,

Cor

ticos

tero

idOt

her t

han

Ultra

Coum

adin

War

farin

Bloo

d Th

inne

rAn

ticoa

gula

ntOt

her t

han

Ultra

Cove

ra-H

SVe

rapa

mil

Card

iac-

Calci

um C

hann

el B

lock

erAn

tihyp

erte

nsive

, Vas

cula

r Hea

dach

esUs

ually

Ultr

aCo

zaar

Losa

rtan

Hype

rtens

ion

Antih

yper

tens

iveUs

ually

Ultr

aCr

ixiva

nHI

VAn

tiret

rovir

alNo

t Ins

urab

leCr

omol

ynCr

omol

ynRe

spira

tory

Inha

ler/N

ebul

izer

Alle

rgy,

Antia

sthm

atic

Usua

lly U

ltra

Cupr

imin

ePe

nicil

lam

ine

Rheu

mat

oid

Arth

ritis

DMAR

D, Im

mun

osup

pres

sant

Othe

r tha

n Ul

traCy

clobe

nzap

rine

Cyclo

benz

aprin

eM

uscle

Spa

sms

Skel

etal

Mus

cle R

elax

ant

Othe

r tha

n Ul

traCy

cloph

osph

amid

eCa

ncer

Canc

erNo

t Ins

urab

leCy

close

rine

Alzh

eim

er’s

Alzh

eim

er's

Dise

ase

Not I

nsur

able

Cyclo

spor

ine

Cyclo

spor

ine

Arth

ritis,

Ulce

rativ

e Co

litis

Imm

unos

uppr

essa

ntOt

her t

han

Ultra

Cyle

rtPe

mol

ine

Stim

ulan

t, AD

HDCe

ntal

Ner

vous

Sys

tem

Stim

ulan

tUs

ually

Ultr

aCy

mba

ltaDe

pres

sion

Anti

Psyc

hotic

Not I

nsur

able

Cyst

ospa

zHy

oscy

amin

eUr

inar

y, Ga

stro

inte

stin

alAn

tispa

smod

ic, A

ntich

olin

ergi

cUs

ually

Ultr

aCy

tom

elLio

thyr

onin

eTh

yroi

d Pr

epar

atio

nsHo

rmon

eUs

ually

Ultr

aCy

tote

cM

isopr

osto

lGa

stro

inte

stin

al-P

reve

nt G

I ulce

rsAn

tiulce

r Age

ntUs

ually

Ultr

aCy

toxa

nCy

cloph

osph

amid

eCa

ncer

, Rhe

umat

oid

Arth

ritis

Imm

unos

uppr

essa

ntNo

t Ins

urab

le

DDa

lalo

neDe

xam

etha

sone

Ster

oid

Antia

sthm

atic,

Cor

ticos

tero

idOt

her t

han

Ultra

Dalm

ane

Flura

zepa

mSl

eepi

ng P

illSe

dativ

e/Hy

pnot

icUs

ually

Ultr

aDa

ntriu

mM

ultip

le S

clero

sisM

ultip

le S

clero

sisNo

t Ins

urab

leDa

ntro

lene

Cere

bral

Pal

syAn

ti sp

asm

odic

Not I

nsur

able

Darv

ocet

-NPr

opox

yphe

ne/A

ceta

min

ophe

nNa

rcot

ic Pa

in M

edica

tion

Opio

id A

nalg

esic

Call

Darv

onPr

opox

yphe

neNa

rcot

ic Pa

in M

edica

tion

Opio

id A

nalg

esic

Call

Dayp

roOx

apro

zinAr

thrit

is, P

ain

NSAI

D, A

ntirh

eum

atic

Othe

r tha

n Ul

traDe

cadr

onDe

xam

etha

sone

Ster

oid

Antia

sthm

atic,

Cor

ticos

tero

idOt

her t

han

Ultra

FOR

PROD

UCER

USE

ON

LY. N

OT F

OR U

SE W

ITH

THE

PUBL

IC.

56

Drug

-Gen

eric

Ge

neric

Nam

eDe

scrip

tion/

Ther

apeu

tic C

lass

Prob

able

Act

ion

& T

rade

Nam

esCo

nditi

ons

Trea

ted

Declo

fena

cDe

clofe

nac

Arth

ritis

NSAI

DOt

her t

han

Ultra

Dela

virdi

neDe

lavir

dine

HIV

Infe

ctio

nAn

tiret

rovir

alNo

t Ins

urab

leDe

mad

exTo

rsem

ide

Edem

aDi

uret

icOt

her t

han

Ultra

Dem

erol

Mep

erid

ine

Narc

otic

Pain

Med

icatio

nOp

ioid

Ana

lges

icCa

llDe

pake

neVa

lpro

ic Ac

idSe

izure

Diso

rder

Antic

onvu

lsant

, Vas

cula

r Hea

dach

esOt

her t

han

Ultra

Depa

kote

Diva

lpro

ex S

odiu

mSe

izure

Diso

rder

Antic

onvu

lsant

, Vas

cula

r Hea

dach

esOt

her t

han

Ultra

Depo

Med

rol

Met

hylp

redn

isolo

neSt

eroi

dAn

tiast

hmat

ic, C

ortic

oste

roid

Othe

r tha

n Ul

traDe

poni

tNi

togl

ycer

inCa

rdia

c-Ni

trate

Anti-

Angi

nal

Othe

r tha

n Ul

traDe

po P

rove

raCa

ncer

Canc

erNo

t Ins

urab

leDe

pryn

elDe

men

tia, P

arkin

son’s

Anti

Park

inso

n’sNo

t Ins

urab

leDe

sCa

ncer

Canc

erNo

t Ins

urab

leDe

sipra

min

eDe

sipra

min

eDe

pres

sion

Antid

epre

ssan

tOt

her t

han

Ultra

Desy

rel

Traz

odon

eDe

pres

sion

Antid

epre

ssan

tOt

her t

han

Ultra

Detro

lTo

ltero

dine

Urin

ary-

Blad

der

Antic

holin

ergi

cUs

ually

Ultr

aDe

xedr

ine

Dext

roam

phet

amin

eSt

imul

ant,

ADHD

, Nar

cole

psy

Cent

al N

ervo

us S

yste

m S

timul

ant

Othe

r tha

n Ul

traDi

aBet

aGl

ybur

ide

(NID

DM)

Antid

iabe

ticOt

her t

han

Ultra

Diab

ines

eDi

abet

es N

DDM

Antid

iabe

tes

Othe

r tha

n Ul

traDi

azep

amDi

azep

amRe

laxa

ntAn

ticon

vulsa

ntOt

her t

han

Ultra

Didr

onel

Etid

rona

teOs

teop

oros

is, P

aget

’sHy

poca

lcem

icOt

her t

han

Ultra

Diflu

can

Fluco

nazo

leFu

ngal

Infe

ctio

nsAn

tifun

gal

Usua

lly U

ltra

Digo

xinDi

goxin

Card

iac

Anth

arrh

ythm

icOt

her t

han

Ultra

Dihy

droe

rgot

amin

eDi

hydr

oerg

otam

ine

Mig

rain

esVa

scul

ar H

eada

che

Supp

ress

ant

Usua

lly U

ltra

Dila

cor X

RDi

ltiaz

emCa

rdia

c-Ca

lcium

Cha

nnel

Blo

cker

Antih

perte

nsive

sUs

ually

Ultr

aDi

lant

inPh

enyt

oin

Seizu

re D

isord

erAn

tiarry

thm

ic, A

ntico

nvul

sant

Othe

r tha

n Ul

traDi

latra

te-S

RIso

sorb

ide

Dini

trate

Card

iac-

Nitra

teAn

ti-An

gina

lOt

her t

han

Ultra

Dilti

azem

Dilti

azem

Card

iac-

Calci

um C

hann

el B

lock

erAn

tihpe

rtens

ives

Usua

lly U

ltra

Diov

anVa

lsarta

nHy

perte

nsio

nAn

tihpe

rtens

iveUs

ually

Ultr

aDi

phen

ylhyd

anto

inPh

enyt

oin

Seizu

re D

isord

erAn

tiarry

thm

ic, A

ntico

nvul

sant

Othe

r tha

n Ul

tra

FOR

PROD

UCER

USE

ON

LY. N

OT F

OR U

SE W

ITH

THE

PUBL

IC.

57

Drug

-Gen

eric

Ge

neric

Nam

eDe

scrip

tion/

Ther

apeu

tic C

lass

Prob

able

Act

ion

& T

rade

Nam

esCo

nditi

ons

Trea

ted

Dipy

rimad

ole

Dipy

rimad

ole

Circ

ulat

ory

Antip

late

let A

gent

Not I

nsur

able

Disa

lcid

Salsa

late

Arth

ritis,

Pai

nNS

AID

Othe

r tha

n Ul

traDi

sopy

ram

ide

Diso

pyra

mid

eCa

rdia

cAn

tiarrh

ythm

icOt

her t

han

Ultra

Ditro

pan

Oxyb

utyn

inUr

inar

y-Bl

adde

rAn

ticho

liner

gic

Usua

lly U

ltra

Diur

ilCh

loro

thia

zide

Card

iac,

Edem

aAn

tihyp

erte

nsive

, Diu

retic

Usua

lly U

ltra

Diva

lpro

ex S

odiu

mDi

valp

roex

Sod

ium

Seizu

re D

isord

erAn

ticon

vulsa

nt, V

ascu

lar H

eada

ches

Othe

r tha

n Ul

traDi

zac

Diaz

epam

Rela

xant

Antic

onvu

lsant

Othe

r tha

n Ul

traDo

ceta

xel

Canc

erCa

ncer

Not I

nsur

able

Dolo

phin

eM

etha

done

Narc

otic

Pain

Med

icatio

nOp

ioid

Ana

lges

icNo

t Ins

urab

leDo

lora

cCa

psai

cinPa

in M

anag

emen

t, To

pica

lNo

nopi

oid

Anal

gesic

s (To

pica

l)Ot

her t

han

Ultra

Done

pezil

Done

pezil

Mem

ory

Loss

Anti-

Alzh

eirm

erNo

t Ins

urab

leDo

nnam

arHy

oscy

amin

eUr

inar

y, Ga

stro

inte

stin

alAn

tispa

smod

ic, A

ntich

olin

ergi

cUs

ually

Ultr

aDo

nnat

alne

/Sco

pola

min

e Co

mbo

Gast

roin

test

inal

Gast

roin

test

inal

Usua

lly U

ltra

Dopa

rLe

vodo

paPa

rkin

son’s

Antip

arkin

son

Not I

nsur

able

Doxa

zosin

Doxa

zosin

Card

iac

Antih

yper

tens

iveUs

ually

Ultr

aDo

xepi

nDo

xepi

nDe

pres

sion

Antia

nxie

ty, A

ntid

epre

ssan

tOt

her t

han

Ultra

DPH

Phen

ytoi

nSe

izure

Diso

rder

Antia

rryth

mic,

Ant

iconv

ulsa

ntOt

her t

han

Ultra

Drox

iaHy

drox

yure

aCa

ncer

Antin

eopl

astic

Not I

nsur

able

Duph

alac

Lact

ulos

eGa

stro

inte

stin

al-C

onst

ipat

ion

Laxa

tive

Usua

lly U

ltra

Dura

clon

Clon

idin

eCa

rdia

cAn

tihyp

erte

nsive

Usua

lly U

ltra

Dura

gesic

Fent

anyl

Tran

sder

mal

Opio

id A

nalg

esic

Not I

nsur

able

Dura

lone

Met

hylp

redn

isolo

neSt

eroi

dAn

tiast

hmat

ic, C

ortic

oste

roid

Othe

r tha

n Ul

traDu

ram

orph

Mor

phin

eNa

rcot

ic Pa

in M

edica

tion

Opio

id A

nalg

esic

Not I

nsur

able

Duvo

idBe

than

ecol

Urin

ary-

Blad

der

Urin

ary

Trac

t Stim

ulan

tUs

ually

Ultr

aDy

azid

eHy

droc

hlor

othi

azid

e/Tr

iam

tere

neCa

rdia

cAn

tihyp

erte

nsive

Usua

lly U

ltra

Dyna

Circ

Israd

ipin

eCa

rdia

c-Ca

lcium

Cha

nnel

Blo

cker

Antia

ngin

al, A

ntih

yper

tens

iveOt

her t

han

Ultra

Dym

elor

Diab

etes

Anti

diab

etic

Othe

r tha

n Ul

traDy

reni

umTr

iam

tere

neEd

ema

Diur

etic,

Pot

assiu

m-S

parin

gOt

her t

han

Ultra

FOR

PROD

UCER

USE

ON

LY. N

OT F

OR U

SE W

ITH

THE

PUBL

IC.

58

Drug

-Gen

eric

Ge

neric

Nam

eDe

scrip

tion/

Ther

apeu

tic C

lass

Prob

able

Act

ion

& T

rade

Nam

esCo

nditi

ons

Trea

ted

EEd

ur-A

cinNi

acin

Hype

rcho

lest

erol

emia

, Sup

plem

ent

Lipid

-(fat

)-Low

erin

g dr

ug, V

itam

inUs

ually

Ultr

aEf

fexo

rVe

nlaf

axin

eDe

pres

sion

Antia

nxie

ty, A

ntid

epre

ssan

tOt

her t

han

Ultra

Elav

ilAm

itrip

tylin

eDe

pres

sion,

Chr

onic

Pain

Antid

epre

ssan

tOt

her t

han

Ultra

Elde

pryl

Sele

gilin

ePa

rkin

son‚

Äôs

Antip

arkin

son

Not I

nsur

able

Elixo

phyll

inTh

eoph

yllin

eRe

spira

tory

Bron

chod

ilato

rOt

her t

han

Ultra

Emcy

tCa

ncer

Antin

eopl

astic

Not I

nsur

able

Emtri

vaHI

VAn

tere

trovir

alNo

t Ins

urab

leEn

alap

ril/E

nala

prila

tEn

alap

ril/E

nala

prila

tCa

rdia

cAn

tihyp

erte

nsive

Usua

lly U

ltra

Enbr

elEt

aner

cept

Rheu

mat

oid

Arth

ritis

DMAR

DOt

her t

han

Ultra

Ende

pAm

itrip

tylin

eDe

pres

sion,

Chr

onic

Pain

Antid

epre

ssan

tOt

her t

han

Ultra

Endo

codo

neOx

ycod

one

Narc

otic

Pain

Med

icatio

nOp

ioid

Ana

lges

icNo

t Ins

urab

leEn

taca

pone

Enta

capo

nePa

rkin

son’s

Antip

arkin

son

Not I

nsur

able

Ento

cort

ECBu

deso

nide

Ster

oid

Antia

sthm

atic,

Cor

ticos

tero

idOt

her t

han

Ultra

Enul

ose

Lact

ulos

eGa

stro

inte

stin

al-C

onst

ipat

ion

Laxa

tive

Usua

lly U

ltra

Epito

lCa

rbam

azep

ine

Neur

algi

aAn

ticon

vulsa

ntOt

her t

han

Ultra

Epivi

rHI

VAn

tiret

rovir

alNo

t Ins

urab

leEp

oetin

Epoe

tinAn

emia

of C

hron

ic Re

nal F

ailu

reAn

ti-An

emic

Not I

nsur

able

Eptif

ibat

ide

Eptif

ibat

ide

Card

iac

Antip

late

let A

gem

tNo

t Ins

urab

leEr

gota

min

eEr

gota

min

eM

igra

ines

Vasc

ular

Hea

dach

e Su

ppre

ssan

tUs

ually

Ultr

aEr

gots

tat

Ergo

tam

ine

Mig

rain

esVa

scul

ar H

eada

che

Supp

ress

ant

Usua

lly U

ltra

Eryt

hrop

oiet

in-In

ject

able

Epoe

tinAn

emia

of C

hron

ic Re

nal F

ailu

reAn

ti-An

emic

Not I

nsur

able

Esid

rex

Hydr

ochl

orot

hiaz

ide

Card

iac,

Edem

aAn

tihyp

erte

nsive

, Diu

retic

Usua

lly U

ltra

Eska

lith

Lithi

umM

anic-

Depr

essio

nAn

timan

icNo

t Ins

urab

leEs

mol

olEs

mol

olCa

rdia

c-Be

ta B

lock

erAn

tiarrh

ythm

icOt

her t

han

Ultra

Esom

epra

zole

Esom

epra

zole

Gast

roin

test

inal

Aniu

lcer A

gent

Usua

lly U

ltra

FOR

PROD

UCER

USE

ON

LY. N

OT F

OR U

SE W

ITH

THE

PUBL

IC.

59

Drug

-Gen

eric

Ge

neric

Nam

eDe

scrip

tion/

Ther

apeu

tic C

lass

Prob

able

Act

ion

& T

rade

Nam

esCo

nditi

ons

Trea

ted

Estra

diol

Estra

diol

Estro

gen

Repl

acem

ent T

hera

pyHo

rmon

eUs

ually

Ultr

aEt

aner

cept

Etan

erce

ptRh

eum

atoi

d Ar

thrit

isDM

ARD

Othe

r tha

n Ul

traEt

hmoz

ine

Mor

icizin

eCa

rdia

cAn

tiarrh

ythm

icOt

her t

han

Ultra

Etid

rona

teEt

idro

nate

Oste

opor

osis,

Pag

et’s

Hypo

calce

mic

Othe

r tha

n Ul

traEu

lexin

Fluta

mid

eCa

ncer

Antin

eopl

astic

Not I

nsur

able

Eval

ose

Lact

ulos

eGa

stro

inte

stin

al-C

onst

ipat

ion

Laxa

tive

Usua

lly U

ltra

Evist

aRa

loxif

ene

Oste

opor

osis

Bone

Res

orpt

ion

Inhi

bito

rsOt

her t

han

Ultra

Evox

acCe

vimel

ine

Sjog

ren’s

Syn

drom

eCh

olin

ergi

cOt

her t

han

Ultra

Exel

onRi

vast

igm

ine

Alzh

eim

ers/

Mem

ory

Anti-

Alzh

eirm

erNo

t Ins

urab

le

FFe

lden

ePi

roxic

amAr

thrit

is, P

ain

NSAI

D, A

ntirh

eum

atic

Othe

r tha

n Ul

traFe

nofib

rate

Feno

fibra

teHy

perc

hole

ster

olem

iaLip

id-(f

at)-L

ower

ing

drug

Usua

lly U

ltra

Fent

anyl

Fent

anyl

Narc

otic

Pain

Med

icatio

nOp

ioid

Ana

lges

icNo

t Ins

urab

leFe

osol

Ferro

us S

ulfa

teIro

n-De

ficie

ncy

Anem

iaAn

ti-An

emic

Othe

r tha

n Ul

traFe

rgon

Ferro

us G

luco

nate

Iron-

Defic

ienc

y An

emia

Anti-

Anem

icOt

her t

han

Ultra

Ferro

us G

luco

nate

Ferro

us G

luco

nate

Iron-

Defic

ienc

y An

emia

Anti-

Anem

icOt

her t

han

Ultra

Ferro

us S

ulfa

teFe

rrous

Sul

fate

Iron-

Defic

ienc

y An

emia

Anti-

Anem

icOt

her t

han

Ultra

Fioric

etCo

mbo

Narc

otic

Pain

Med

icatio

nBa

rbitu

ates

Call

Fiorin

alBu

talb

ital/A

spiri

n/Ca

ffein

e Co

mbo

Narc

otic

Pain

Med

icatio

nCa

llFla

gyl

Met

roni

dazo

leIn

fect

ions

Agen

tUs

ually

Ultr

aFle

cain

ide

Fleca

inid

eCa

rdia

cAn

tiarrh

ythm

icOt

her t

han

Ultra

Flexe

rilCy

clobe

nzap

rine

Mus

cle S

pasm

sSk

elet

al M

uscle

Rel

axan

tOt

her t

han

Ultra

Flexo

nOr

phen

adrin

eM

uscle

Spa

sms

Skel

etal

Mus

cle R

elax

ant

Othe

r tha

n Ul

traFlo

vent

Flutic

ason

e In

hale

rRe

spira

tory

Inha

ler

Corti

cors

tero

id In

hale

r, An

tiast

hmat

icOt

her t

han

Ultra

Fluco

nazo

leFlu

cona

zole

Fung

al In

fect

ions

Antif

unga

lUs

ually

Ultr

aFlu

niso

lide

Fluni

solid

e In

hale

rRe

spira

tory

Inha

ler

Corti

cors

tero

id In

hale

r, An

tiast

hmat

icOt

her t

han

Ultra

FOR

PROD

UCER

USE

ON

LY. N

OT F

OR U

SE W

ITH

THE

PUBL

IC.

60

Drug

-Gen

eric

Ge

neric

Nam

eDe

scrip

tion/

Ther

apeu

tic C

lass

Prob

able

Act

ion

& T

rade

Nam

esCo

nditi

ons

Trea

ted

Fluox

etin

eFlu

oxet

ine

Depr

essio

nAn

tidep

ress

ant

Othe

r tha

n Ul

traFlu

phen

azin

eFlu

phen

azin

ePs

ycho

ses

Antip

sych

otic

Not I

nsur

able

Flura

zepa

mFlu

raze

pam

Slee

ping

Pill

Seda

tive/

Hypn

otic

Usua

lly U

ltra

Flurb

ipro

fen

Flurb

ipro

fen

Arth

ritis

NSAI

D, A

ntirh

eum

atic

Othe

r tha

n Ul

traFlu

tam

ide

Fluta

mid

eCa

ncer

Antin

eopl

astic

Not I

nsur

able

Flutic

ason

e In

hale

rFlu

ticas

one

Inha

ler

Resp

irato

ry In

hale

rCo

rtico

rste

roid

Inha

ler,

Antia

sthm

atic

Othe

r tha

n Ul

traFlu

vast

atin

Fluva

stat

inHy

perc

hole

ster

olem

iaLip

id-(f

at)-L

ower

ing

drug

Usua

lly U

ltra

Fluvo

xam

ine

Fluvo

xam

ine

Depr

essio

nAn

tidep

ress

ant

Othe

r tha

n Ul

traFo

late

Folic

Acid

Anem

ia, V

itam

inAn

ti-An

emic

Usua

lly U

ltra

Fole

xM

etho

trexa

teRh

eum

atoi

d Ar

thrit

isDM

ARD,

Imm

unos

uppr

essa

ntOt

her t

han

Ultra

Folic

Acid

Folic

Acid

Anem

ia, V

itam

inAn

ti-An

emic

Usua

lly U

ltra

Folvi

teFo

lic A

cidAn

emia

, Vita

min

Anti-

Anem

icUs

ually

Ultr

aFo

ndap

arin

uxFo

ndap

arin

uxDV

T Pr

ophy

laxis

Antic

oagu

lant

Othe

r tha

n Ul

traFo

rmot

erol

Form

oter

olRe

spira

tory

Inha

ler

Bron

chod

ilato

rOt

her t

han

Ultra

Forte

oOs

teop

oros

isBo

ne R

esor

ptio

n in

hibi

tors

Othe

r tha

n Ul

traFo

sam

axAl

endr

onat

eOs

teop

oros

isBo

ne R

esor

ptio

n In

hibi

tors

Othe

r tha

n Ul

traFr

ovat

ripta

nFr

ovat

ripta

nM

igra

ines

Vasc

ular

Hea

dach

e Su

ppre

ssan

tUs

ually

Ultr

aFu

rose

mid

eFu

rose

mid

eEd

ema

Diur

etic

Usua

lly U

ltra

Fuze

onHI

VAn

tere

trovir

alNo

t Ins

urab

le

FOR

PROD

UCER

USE

ON

LY. N

OT F

OR U

SE W

ITH

THE

PUBL

IC.

61

Drug

-Gen

eric

Ge

neric

Nam

eDe

scrip

tion/

Ther

apeu

tic C

lass

Prob

able

Act

ion

& T

rade

Nam

esCo

nditi

ons

Trea

ted

GGa

lant

amin

eGa

lant

amin

eAl

zhei

mer

s/M

emor

yAn

ti Al

zhei

mer

'sNo

t Ins

urab

leGe

mfib

rozil

Gem

fibro

zilHy

perc

hole

ster

olem

iaLip

id-(f

at)-L

ower

ing

drug

Usua

lly U

ltra

Gen-

Sele

gilin

eSe

legi

line

Park

inso

n’sAn

tipar

kinso

nNo

t Ins

urab

leGe

odon

Zipr

asid

one

Schi

zoph

reni

aAn

tipsy

chot

icNo

t Ins

urab

leGl

atira

mir

Acet

ate

Mul

tiple

Scle

rosis

Imm

unom

odul

ator

-MS

Not I

nsur

able

Glee

vicLe

ukem

iaNo

t Ins

urab

leGl

imep

iride

Glim

epiri

de(N

IDDM

)An

tidia

betic

Othe

r tha

n Ul

traGl

ipizi

deGl

ipizi

de(N

IDDM

)An

tidia

betic

Othe

r tha

n Ul

traGl

ucop

hage

Met

form

in(N

IDDM

)An

tidia

betic

Othe

r tha

n Ul

traGl

ucot

rol

Glip

izide

(NID

DM)

Antid

iabe

ticOt

her t

han

Ultra

Gluc

ovan

ceGl

ybur

ide/

Met

form

in C

ombo

(NID

DM)

Antid

iabe

ticOt

her t

han

Ultra

Glyb

urid

eGl

ybur

ide

(NID

DM)

Antid

iabe

ticOt

her t

han

Ultra

Glyc

opyr

rola

teGl

ycop

yrro

late

Gast

roin

test

inal

-Pep

tic U

lcer D

iseas

eAn

tispa

smod

ic, A

ntich

olin

ergi

cUs

ually

Ultr

aGl

ynas

eGl

ybur

ide

(NID

DM)

Antid

iabe

ticOt

her t

han

Ultra

Glys

etM

iglit

ol(N

IDDM

)An

tidia

betic

Othe

r tha

n Ul

tra

HHa

lope

ridol

Halo

perid

olPs

ycho

ses

Antip

sych

otic

Not I

nsur

able

HCTZ

Hydr

ochl

orot

hiaz

ide

Card

iac,

Edem

aAn

tihyp

erte

nsive

, Diu

retic

Usua

lly U

ltra

Hepa

rin In

ject

able

Hepa

rin In

ject

able

Bloo

d Th

inne

rAn

ticoa

gula

ntNo

t Ins

urab

leHe

ptal

acLa

ctul

ose

Gast

roin

test

inal

-Con

stip

atio

nLa

xativ

eUs

ually

Ultr

aHe

xadr

olDe

xam

etha

sone

Ster

oid

Antia

sthm

atic,

Cor

ticos

tero

idOt

her t

han

Ultra

Hexa

len

Canc

erAn

tineo

plas

ticNo

t Ins

urab

leHi

vidHI

VAn

tere

trovir

alNo

t Ins

urab

leHy

dorm

orph

one

Hydo

rmor

phon

eNa

rcot

ic Pa

in M

edica

tion

Opio

id A

nalg

esic

Not I

nsur

able

FOR

PROD

UCER

USE

ON

LY. N

OT F

OR U

SE W

ITH

THE

PUBL

IC.

62

Drug

-Gen

eric

Ge

neric

Nam

eDe

scrip

tion/

Ther

apeu

tic C

lass

Prob

able

Act

ion

& T

rade

Nam

esCo

nditi

ons

Trea

ted

Hydr

alaz

ine

Hydr

alaz

ine

Card

iac

Antih

yper

tens

iveUs

ually

Ultr

aHy

drea

Hydr

oxyu

rea

Canc

erAn

tineo

plas

ticNo

t Ins

urab

leHy

droc

etCo

mbo

Narc

otic

Pain

Med

icatio

nOp

ioid

Ana

lges

icNo

t Ins

urab

leHy

droc

hlor

othi

azid

eHy

droc

hlor

othi

azid

eCa

rdia

c, Ed

ema

Antih

yper

tens

ive, D

iure

ticUs

ually

Ultr

aHy

droc

odon

eHy

droc

odon

eNa

rcot

ic pa

in m

edica

tion

Opio

id A

nalg

esic

Not I

nsur

able

Hydr

ocor

tison

eHy

droc

ortis

one

Ster

oid

Antia

sthm

atic,

Cor

ticos

tero

idOt

her t

han

Ultra

Hydr

oDiu

rilHy

droc

hlor

othi

azid

eCa

rdia

c, Ed

ema

Antih

yper

tens

ive, D

iure

ticUs

ually

Ultr

aHy

drop

res

Com

boCa

rdia

cAn

tihyp

erte

nsive

Usua

lly U

ltra

Hydr

oxyu

rea

Hydr

oxyu

rea

Canc

erAn

tineo

plas

ticNo

t Ins

urab

leHy

drox

yzin

eHy

drox

yzin

eAn

xiety,

Itch

ing,

Sed

atio

nAn

tihist

amin

eUs

ually

Ultr

aHy

grot

onCh

lorth

alid

one

Card

iac,

Edem

aAn

tihyp

erte

nsive

, Diu

retic

Usua

lly U

ltra

Hylo

rel

Guan

adre

lCa

rdia

cAn

tihyp

erte

nsive

Usua

lly U

ltra

Hyos

cyam

ine

Hyos

cyam

ine

Urin

ary,

Gast

roin

test

inal

Antis

pasm

odic,

Ant

ichol

iner

gic

Usua

lly U

ltra

Hytri

nTe

razo

sinCa

rdia

c, Pr

osta

te E

nlar

gem

ent

Antih

yper

tens

ive, B

PHUs

ually

Ultr

aHy

zine-

50Hy

drox

yzin

eAn

xiety,

Itch

ing,

Sed

atio

nAn

tihist

amin

eUs

ually

Ultr

a

IIb

upro

fen

Ibup

rofe

nAr

thrit

isNS

AID

Othe

r tha

n Ul

traIb

utili

deIb

utili

deCa

rdia

cAn

tiarrh

ythm

icsOt

her t

han

Ultra

Imdu

rIso

sorb

ide

Mon

onitr

ate

Card

iac-

Nitra

teAn

ti-An

gina

lOt

her t

han

Ultra

Imip

ram

ine

Imip

ram

ine

Depr

essio

nAn

tidep

ress

ant

Othe

r tha

n Ul

traIm

itrex

Sum

atrip

tan

Mig

rain

esVa

scul

ar H

eada

che

Supp

ress

ant

Usua

lly U

ltra

Imod

ium

Lope

ram

ide

Diar

rhea

Antid

iarrh

eal

Usua

lly U

ltra

Impr

ilIm

ipra

min

eDe

pres

sion

Antid

epre

ssan

tOt

her t

han

Ultra

Imur

anAz

atho

prin

eAr

thrit

is, C

rohn

’sIm

mun

osup

pres

sant

Not I

nsur

able

Inda

pam

ide

Inda

pam

ide

Card

iac,

Edem

aAn

tihyp

erte

nsive

, Diu

retic

Othe

r tha

n Ul

traIn

dera

lPr

opan

olol

Card

iac-

Beta

Blo

cker

, Mig

rain

esAn

tihyp

erte

nsive

, Vas

cula

r Hea

dach

esUs

ually

Ultr

a

FOR

PROD

UCER

USE

ON

LY. N

OT F

OR U

SE W

ITH

THE

PUBL

IC.

63

Drug

-Gen

eric

Ge

neric

Nam

eDe

scrip

tion/

Ther

apeu

tic C

lass

Prob

able

Act

ion

& T

rade

Nam

esCo

nditi

ons

Trea

ted

Inde

ride

Com

boCa

rdia

cAn

tihyp

erte

nsive

Usua

lly U

ltra

Indo

cinIn

dom

etha

cinAr

thrit

is, P

ain

NSAI

D, A

ntirh

eum

atic

Othe

r tha

n Ul

traIn

fum

orph

Mor

phin

eNa

rcot

ic Pa

in M

edica

tion

Opio

id A

nalg

esic

Not I

nsur

able

Insu

lin, H

umul

in 5

0/50

NPH/

Regu

lar I

nsul

in M

ixtur

esDi

abet

es, I

nsul

in-D

epen

dent

(IDD

M)

Antid

iabe

ticNo

t Ins

urab

leIn

sulin

, Hum

ulin

70/

30NP

H/Re

gula

r Ins

ulin

Mixt

ures

Diab

etes

, Ins

ulin

-Dep

ende

nt (I

DDM

)An

tidia

betic

Not I

nsur

able

Insu

lin, H

umul

in L

Lent

e In

sulin

Diab

etes

, Ins

ulin

-Dep

ende

nt (I

DDM

)An

tidia

betic

Not I

nsur

able

Insu

lin, H

umul

in N

NPH

Insu

linDi

abet

es, I

nsul

in-D

epen

dent

(IDD

M)

Antid

iabe

ticNo

t Ins

urab

leIn

sulin

, Hum

ulin

U U

ltral

ente

Insu

lin, E

xten

ded

Diab

etes

, Ins

ulin

-Dep

ende

nt (I

DDM

)An

tidia

betic

Not I

nsur

able

Insu

lin, H

umul

in-R

Regu

lar I

nsul

inDi

abet

es, I

nsul

in-D

epen

dent

(IDD

M)

Antid

iabe

ticNo

t Ins

urab

leIn

sulin

, Ile

tin II

RRe

gula

r Ins

ulin

Diab

etes

, Ins

ulin

-Dep

ende

nt (I

DDM

)An

tidia

betic

Not I

nsur

able

Insu

lin, L

ente

Ilet

in II

Lent

e In

sulin

Diab

etes

, Ins

ulin

-Dep

ende

nt (I

DDM

)An

tidia

betic

Not I

nsur

able

Insu

lin, N

ovol

in 7

0/30

NPH/

Regu

lar I

nsul

in M

ixtur

esDi

abet

es, I

nsul

in-D

epen

dent

(IDD

M)

Antid

iabe

ticNo

t Ins

urab

leIn

sulin

, Nov

olin

LLe

nte

Insu

linDi

abet

es, I

nsul

in-D

epen

dent

(IDD

M)

Antid

iabe

ticNo

t Ins

urab

leIn

sulin

, Nov

olin

NNP

H In

sulin

Diab

etes

, Ins

ulin

-Dep

ende

nt (I

DDM

)An

tidia

betic

Not I

nsur

able

Insu

lin, N

ovol

in R

Regu

lar I

nsul

inDi

abet

es, I

nsul

in-D

epen

dent

(IDD

M)

Antid

iabe

ticNo

t Ins

urab

leIn

sulin

, Nov

olin

UIn

sulin

, Ext

ende

dDi

abet

es, I

nsul

in-D

epen

dent

(IDD

M)

Antid

iabe

ticNo

t Ins

urab

leIn

sulin

, NPH

Ilet

in II

NPH

Insu

linDi

abet

es, I

nsul

in-D

epen

dent

(IDD

M)

Antid

iabe

ticNo

t Ins

urab

leIn

sulin

, Ultr

alen

te U

Insu

lin, E

xten

ded

Diab

etes

, Ins

ulin

-Dep

ende

nt (I

DDM

)An

tidia

betic

Not I

nsur

able

Insu

lin, V

elos

ulin

BR

Regu

lar I

nsul

inDi

abet

es, I

nsul

in-D

epen

dent

(IDD

M)

Antid

iabe

ticNo

t Ins

urab

leIn

sulin

; Hum

alog

Insu

lin L

ispro

Diab

etes

, Ins

ulin

-Dep

ende

nt (I

DDM

)An

tidia

betic

Not I

nsur

able

Insu

lin; H

umal

og 5

0/50

Insu

lin L

ispro

/Pro

tam

ine

Mixt

ure

Diab

etes

, Ins

ulin

-Dep

ende

nt (I

DDM

)An

tidia

betic

Not I

nsur

able

Insu

lin; H

umal

og 7

5/25

Insu

lin L

ispro

/Pro

tam

ine

Mixt

ure

Diab

etes

, Ins

ulin

-Dep

ende

nt (I

DDM

)An

tidia

betic

Not I

nsur

able

Insu

lin; N

ovol

ogIn

sulin

Asp

art

Diab

etes

, Ins

ulin

-Dep

ende

nt (I

DDM

)An

tidia

betic

Not I

nsur

able

Insu

lin; L

antu

sIn

sulin

Gla

rgin

eDi

abet

es, I

nsul

in-D

epen

dent

(IDD

M)

Antid

iabe

ticNo

t Ins

urab

leIn

tal

Crom

olyn

Resp

irato

ry In

hale

r/Neb

ulize

rAl

lerg

y, An

tiast

hmat

icUs

ually

Ultr

aIn

terfe

ron

Canc

er/ M

ultip

le S

clero

sisAn

tineo

plas

ticNo

t Ins

urab

leIn

viras

eHI

VAn

tere

trovir

alNo

t Ins

urab

leIrb

esar

tan

Irbes

arta

nHy

perte

nsio

nAn

tihyp

erte

nsive

Usua

lly U

ltra

FOR

PROD

UCER

USE

ON

LY. N

OT F

OR U

SE W

ITH

THE

PUBL

IC.

64

Drug

-Gen

eric

Ge

neric

Nam

eDe

scrip

tion/

Ther

apeu

tic C

lass

Prob

able

Act

ion

& T

rade

Nam

esCo

nditi

ons

Trea

ted

Iso-B

idIso

sorb

ide

Dini

trate

Card

iac-

Nitra

teAn

ti-An

gina

lOt

her t

han

Ultra

Isona

teIso

sorb

ide

Dini

trate

Card

iac-

Nitra

teAn

ti-An

gina

lOt

her t

han

Ultra

Isorb

idIso

sorb

ide

Dini

trate

Card

iac-

Nitra

teAn

ti-An

gina

lOt

her t

han

Ultra

Isord

ilIso

sorb

ide

Dini

trate

Card

iac-

Nitra

teAn

ti-An

gina

lOt

her t

han

Ultra

Isoso

rbid

e Di

nitra

teIso

sorb

ide

Dini

trate

Card

iac-

Nitra

teAn

ti-An

gina

lOt

her t

han

Ultra

Isotra

te E

RIso

sorb

ide

Mon

onitr

ate

Card

iac-

Nitra

teAn

ti-An

gina

lOt

her t

han

Ultra

JJa

nuvia

Diab

etes

Anti

diab

etic

Othe

r tha

n Ul

traIsr

adip

ine

Israd

ipin

eCa

rdia

c-Ca

lcium

Cha

nnel

Blo

cker

Antia

ngin

al, A

ntih

yper

tens

iveOt

her t

han

Ultra

KKa

bolin

-Inje

ctab

leNa

ndro

lone

Dec

anoa

teAn

emia

of R

enal

Fai

lure

Anti-

anem

icNo

t Ins

urab

leKa

dian

Mor

phin

eNa

rcot

ic Pa

in M

edica

tion

Opio

id A

nalg

esic

Not I

nsur

able

K-Du

rPo

tass

ium

Sup

plem

ent

Pota

ssiu

m S

uppl

emen

tPo

tass

ium

Rep

lace

men

tUs

ually

Ultr

aKa

letra

HIV

Ante

retro

viral

Not I

nsur

able

Kem

adrin

Park

inso

n’s D

iseas

eAn

ti Pa

rkin

son

Not I

nsur

able

Kena

cort

Tria

mcin

olon

eSt

eroi

dAn

tiast

hmat

ic, C

ortic

oste

roid

Othe

r tha

n Ul

traKe

rlone

Beta

xolo

lCa

rdia

c- B

eta

Bloc

ker

Antih

yper

tens

iveUs

ually

Ultr

aKe

topr

ofen

Keto

prof

enAr

thrit

is, P

ain

NSAI

DOt

her t

han

Ultra

Klon

opin

Clon

azep

amSe

izure

Diso

rder

Antic

onvu

lsant

Othe

r tha

n Ul

traK-

Lor

Pota

ssiu

m S

uppl

emen

tPo

tass

ium

Sup

plem

ent

Pota

ssiu

m R

epla

cem

ent

Usua

lly U

ltra

Klor

-Con

Pota

ssiu

m S

uppl

emen

tPo

tass

ium

Sup

plem

ent

Pota

ssiu

m R

epla

cem

ent

Usua

lly U

ltra

Klor

vess

Pota

ssiu

m S

uppl

emen

tPo

tass

ium

Sup

plem

ent

Pota

ssiu

m R

epla

cem

ent

Usua

lly U

ltra

FOR

PROD

UCER

USE

ON

LY. N

OT F

OR U

SE W

ITH

THE

PUBL

IC.

65

Drug

-Gen

eric

Ge

neric

Nam

eDe

scrip

tion/

Ther

apeu

tic C

lass

Prob

able

Act

ion

& T

rade

Nam

esCo

nditi

ons

Trea

ted

K-No

rmPo

tass

ium

Sup

plem

ent

Pota

ssiu

m S

uppl

emen

tPo

tass

ium

Rep

lace

men

tUs

ually

Ultr

aKr

italo

seLa

ctul

ose

Gast

roin

test

inal

-Con

stip

atio

nLa

xativ

eUs

ually

Ultr

aK-

Tab

Pota

ssiu

m S

uppl

emen

tPo

tass

ium

Sup

plem

ent

Pota

ssiu

m R

epla

cem

ent

Usua

lly U

ltra

LLa

beta

lol

Labe

talo

lCa

rdia

c- B

eta

Bloc

ker

Antia

ngin

al, A

ntih

yper

tens

iveOt

her t

han

Ultra

Lact

ulos

eLa

ctul

ose

Gast

roin

test

inal

-Con

stip

atio

nLa

xativ

eUs

ually

Ultr

aLa

mict

alLa

mot

rigin

eSe

izure

Diso

rder

Antic

onvu

lsant

Othe

r tha

n Ul

traLa

noph

yllin

Theo

phyll

ine

Resp

irato

ryBr

onch

odila

tor

Othe

r tha

n Ul

traLa

noxic

aps

Digo

xinCa

rdia

cAn

thar

rhyt

hmic

Othe

r tha

n Ul

traLa

noxin

Digo

xinCa

rdia

cAn

thar

rhyt

hmic

Othe

r tha

n Ul

traLa

nzac

Depr

essio

nAn

ti Ps

ycho

ticNo

t Ins

urab

leLa

rgac

tilCh

lorp

rom

azin

ePs

ycho

ses

Antip

sych

otics

, Ant

iem

etic

Not I

nsur

able

Laro

dopa

Levo

dopa

Park

inso

n’sAn

tipar

kinso

nNo

t Ins

urab

leLa

sixFu

rose

mid

eEd

ema

Diur

etic

Usua

lly U

ltra

L-Do

paLe

vodo

paPa

rkin

son’s

Antip

arkin

son

Not I

nsur

able

Lesc

olFlu

vast

atin

Hype

rcho

lest

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emia

Lipid

-(fat

)-Low

erin

g dr

ugUs

ually

Ultr

aLe

ucov

orin

Canc

erAn

tineo

plas

ticNo

t Ins

urab

leLe

uker

anCh

lora

mbu

cilCa

ncer

Antn

eopl

astic

, Im

mun

osup

pres

sant

Not I

nsur

able

Leva

lbut

erol

Leva

lbut

erol

Resp

irato

ry In

hale

rBr

onch

odila

tor

Othe

r tha

n Ul

traLe

vetir

acet

amLe

vetir

acet

amSe

izure

Diso

rder

Antic

onvu

lsant

Othe

r tha

n Ul

traLe

vodo

paLe

vodo

paPa

rkin

son’s

Antip

arkin

son

Not I

nsur

able

Levo

thro

idLe

voth

yrox

ine

Thyr

oid

Prep

arat

ions

Horm

one

Usua

lly U

ltra

Levo

thyr

oxin

eLe

voth

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ine

Thyr

oid

Prep

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ions

Horm

one

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lly U

ltra

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xyl

Levo

thyr

oxin

eTh

yroi

d Pr

epar

atio

nsHo

rmon

eUs

ually

Ultr

aLe

vsin

Hyos

cyam

ine

Urin

ary,

Gast

roin

test

inal

Antis

pasm

odic,

Ant

ichol

iner

gic

Usua

lly U

ltra

Lexa

pro

Depr

essio

n An

tidep

ress

ant

Othe

r tha

n Ul

tra

FOR

PROD

UCER

USE

ON

LY. N

OT F

OR U

SE W

ITH

THE

PUBL

IC.

66

Drug

-Gen

eric

Ge

neric

Nam

eDe

scrip

tion/

Ther

apeu

tic C

lass

Prob

able

Act

ion

& T

rade

Nam

esCo

nditi

ons

Trea

ted

eLex

ivaHI

VNo

t Ins

urab

leLib

rium

Chlo

rdia

zepo

xide

Anxie

ty-B

enzo

diaz

epin

eAn

tianx

iety,

Sed

ative

/Hyp

notic

Usua

lly U

ltra

Limbi

trol

Com

boAn

xiety,

Dep

ress

ion

Skel

etal

Mus

cle R

elax

ant

Othe

r tha

n Ul

traLio

resa

lBa

clofe

nLe

sions

Antis

past

icity

Age

ntNo

t Ins

urab

leLio

trix

Liotri

xTh

yroi

d Pr

epar

atio

nsHo

rmon

eUs

ually

Ultr

aLip

itor

Ator

vast

atin

Hype

rcho

lest

erol

emia

Lipid

-(fat

)-Low

erin

g dr

ugUs

ually

Ultr

aLis

inop

rilLis

inop

rilCa

rdia

cAn

tihyp

erte

nsive

Usua

lly U

ltra

Lispr

oDi

abet

esAn

ti di

abet

icOt

her t

han

Ultra

Lithi

umLit

hium

Man

ic-De

pres

sion

Antim

anic

Not I

nsur

able

LoCH

OLES

TCh

oles

tyra

min

eHy

perc

hole

ster

olem

iaLip

id-(f

at)-L

ower

ing

drug

Usua

lly U

ltra

Lodi

neEt

odol

acAr

thrit

is, P

ain

Antir

heum

atic,

Non

opio

d An

alge

sicOt

her t

han

Ultra

Lom

otil

Diph

enox

ylate

/Atro

pine

Diar

rhea

Antid

iarrh

eal

Usua

lly U

ltra

Loni

ten

Min

oxid

ilCa

rdia

cAn

tihyp

erte

nsive

Usua

lly U

ltra

Lono

xDi

phen

oxyla

te/A

tropi

neDi

arrh

eaAn

tidia

rrhea

lUs

ually

Ultr

aLo

pera

mid

eLo

pera

mid

eDi

arrh

eaAn

tidia

rrhea

lUs

ually

Ultr

aLo

pid

Gem

fibro

zilHy

perc

hole

ster

olem

iaLip

id-(f

at)-L

ower

ing

drug

Usua

lly U

ltra

Lopr

esso

rM

etop

rolo

lCa

rdia

cAn

tiang

inal

, Ant

ihyp

erte

nsive

Usua

lly U

ltra

Lopu

rinAl

lopu

rinol

Gout

Antig

out A

gent

Usua

lly U

ltra

Lora

zepa

mLo

raze

pam

Anxie

tyAn

tianx

iety,

Sed

ative

/Hyp

notic

Othe

r tha

n Ul

traLo

rcet

Hydr

ocod

one/

Acet

amin

ophe

nNa

rcot

ic Pa

in M

edica

tion

Opio

id A

nalg

esic

Not I

nsur

able

Lorta

bNa

rcot

icAn

alge

sicCa

llLo

sarta

nLo

sarta

nHy

perte

nsio

nAn

tihyp

erte

nsive

Usua

lly U

ltra

Lote

nsin

Bena

zepr

ilCa

rdia

cAn

tihyp

erte

nsive

Usua

lly U

ltra

Lotre

lBe

naze

pril/

Amlo

dipi

ne C

ombo

Card

iac

Antih

yper

tens

iveUs

ually

Ultr

aLo

vast

atin

Lova

stat

inHy

perc

hole

ster

olem

iaLip

id-(f

at)-L

ower

ing

drug

Usua

lly U

ltra

Lozo

lIn

dapa

mid

eCa

rdia

c, Ed

ema

Antih

yper

tens

ive, D

iure

ticUs

ually

Ultr

al

FOR

PROD

UCER

USE

ON

LY. N

OT F

OR U

SE W

ITH

THE

PUBL

IC.

67

Drug

-Gen

eric

Ge

neric

Nam

eDe

scrip

tion/

Ther

apeu

tic C

lass

Prob

able

Act

ion

& T

rade

Nam

esCo

nditi

ons

Trea

ted

Lupr

onCa

ncer

Antin

eopl

astic

Not I

nsur

able

Luvo

xFlu

voxa

min

eDe

pres

sion

Antid

epre

ssan

tOt

her t

han

Ultra

Lyric

aEp

ileps

yAn

ti se

izure

/ner

ve p

ain

Othe

r tha

n Ul

tra

MM

arth

ritic

Salsa

late

Arth

ritis,

Pai

nNS

AID

Othe

r tha

n Ul

traM

axai

r Inh

aler

Pirb

uter

olRe

spira

tory

Inha

ler

Bron

chod

ilato

rOt

her t

han

Ultra

Max

alt

Riza

tript

anM

igra

ines

Vasc

ular

Hea

dach

e Su

ppre

ssan

tUs

ually

Ultr

aM

ecliz

ine

Mec

lizin

eM

otio

n Si

ckne

ss, V

ertig

oAn

tiem

etics

, Ant

ihist

amin

esOt

her t

han

Ultra

Med

rol

Met

hylp

redn

isolo

neSt

eroi

dAn

tiast

hmat

ic, C

ortic

oste

roid

Othe

r tha

n Ul

traM

edro

xypr

oges

tero

neM

edro

xypr

oges

tero

neHo

rmon

e Re

plac

emen

tHo

rmon

eUs

ually

Ultr

aM

egac

eCa

ncer

Antin

eopl

astic

Not I

nsur

able

Meg

estro

lCa

ncer

Antin

eopl

astic

Not I

nsur

able

Mel

laril

Thio

ridaz

ine

Schi

zoph

reni

aAn

tipsy

chot

icNo

t Ins

urab

leM

elph

alan

Canc

erAn

tineo

plas

ticNo

t Ins

urab

leM

eper

idin

eM

eper

idin

eNa

rcot

ic Pa

in M

edica

tion

Opio

id A

nalg

esic

Not I

nsur

able

Mes

tinon

Mya

sthe

nia

Grav

isNo

t Ins

urab

leM

etfo

rmin

Met

form

in(N

IDDM

)An

tidia

betic

Othe

r tha

n Ul

traM

etha

done

Met

hado

neNa

rcot

ic Pa

in M

edica

tion

Opio

id A

nalg

esic

Not I

nsur

able

Met

hoca

rbam

olM

etho

carb

amol

Mus

cle S

pasm

sSk

elet

al M

uscle

Rel

axan

tOt

her t

han

Ultra

Met

hotre

xate

Met

hotre

xate

Rheu

mat

oid

Arth

ritis

DMAR

D, Im

mun

osup

pres

sant

Othe

r tha

n Ul

traM

ethy

ldop

aM

ethy

ldop

aCa

rdia

cAn

tihyp

erte

nsive

Usua

lly U

ltra

Mev

acor

Lova

stat

inHy

perc

hole

ster

olem

iaLip

id-(f

at)-L

ower

ing

drug

Usua

lly U

ltra

Mia

calci

n In

ject

ion

Calci

toni

nOs

teop

oros

is, P

aget

’sHy

poca

lcem

icOt

her t

han

Ultra

Mica

rdis

Telm

isarta

nHy

perte

nsio

nAn

tihyp

erte

nsive

Usua

lly U

ltra

Micr

o-K

Pota

ssiu

m S

uppl

emen

tPo

tass

ium

Sup

plem

ent

Pota

ssiu

m R

epla

cem

ent

Usua

lly U

ltra

Micr

onas

eGl

ybur

ide

(NID

DM)

Antid

iabe

ticOt

her t

han

Ultra

FOR

PROD

UCER

USE

ON

LY. N

OT F

OR U

SE W

ITH

THE

PUBL

IC.

68

Drug

-Gen

eric

Ge

neric

Nam

eDe

scrip

tion/

Ther

apeu

tic C

lass

Prob

able

Act

ion

& T

rade

Nam

esCo

nditi

ons

Trea

ted

Mig

litol

Mig

litol

(NID

DM)

Antid

iabe

ticOt

her t

han

Ultra

Mig

rana

lDi

hydr

oerg

otam

ine

Mig

rain

esVa

scul

ar H

eada

che

Supp

ress

ant

Usua

lly U

ltra

Milo

ntin

Epile

psy

Antic

onvu

lsant

Othe

r tha

n Ul

traM

inip

ress

Praz

osin

Card

iac,

Pros

tate

Enl

arge

men

tAn

tihyp

erte

nsive

, BPH

Usua

lly U

ltra

Min

itran

Nito

glyc

erin

Card

iac-

Nitra

teAn

ti-An

gina

lOt

her t

han

Ultra

Min

oxid

ilM

inox

idil

Card

iac

Antih

yper

tens

iveUs

ually

Ultr

aM

irape

xPr

amip

exol

ePa

rkin

sons

Antip

arkin

son

Not I

nsur

able

Mob

icAr

thrit

isNS

AID

Othe

r tha

n Ul

traM

olin

done

Depr

essio

nAn

tipsy

chot

icNo

t Ins

urab

leM

onok

etIso

sorb

ide

Mon

onitr

ate

Card

iac-

Nitra

teAn

ti-An

gina

lOt

her t

han

Ultra

Mon

opril

Fosin

opril

Card

iac

Antih

yper

tens

iveUs

ually

Ultr

aM

orph

ine

Mor

phin

eNa

rcot

ic Pa

in M

edica

tion

Opio

id A

nalg

esic

Not I

nsur

able

Mot

ofen

Defe

noxin

/Atro

pine

Diar

rhea

Antid

iarrh

eal

Usua

lly U

ltra

Mot

rinIb

upro

fen

Arth

ritis,

Pai

nNS

AID

Usua

lly U

ltra

MS

Cont

inM

orph

ine

Narc

otic

Pain

Med

icatio

nOp

ioid

Ana

lges

icNo

t Ins

urab

leM

utam

ycin

Canc

erNo

t Ins

urab

leM

ylera

nCa

ncer

Not I

nsur

able

Myo

trol

Orph

enad

rine

Mus

cle S

pasm

sSk

elet

al M

uscle

Rel

axan

tOt

her t

han

Ultra

Mys

olin

ePr

imad

one

Seizu

re D

isord

erOt

her t

han

Ultra

NNa

bum

eton

eNa

bum

eton

eAr

thrit

is, P

ain

NSAI

D, A

ntirh

eum

atic

Othe

r tha

n Ul

traNa

lfon

Arth

ritis

Anti

arth

ritic

Othe

r tha

n Ul

traNa

ltrex

one

Alco

holis

mAn

tirhe

umat

icNo

t Ins

urab

leNa

men

daAl

zhei

mer

’sAn

ti de

men

tiaNo

t Ins

urab

leNa

ndro

lone

Dec

anoa

teNa

ndro

lone

Dec

anoa

teAn

emia

of R

enal

Fai

lure

Anti-

anem

icNo

t Ins

urab

leNa

prox

enNa

prox

enAr

thrit

is, P

ain

NSAI

DOt

her t

han

Ultra

FOR

PROD

UCER

USE

ON

LY. N

OT F

OR U

SE W

ITH

THE

PUBL

IC.

69

Drug

-Gen

eric

Ge

neric

Nam

eDe

scrip

tion/

Ther

apeu

tic C

lass

Prob

able

Act

ion

& T

rade

Nam

esCo

nditi

ons

Trea

ted

Nara

tript

anNa

ratri

ptan

Mig

rain

esVa

scul

ar H

eada

che

Supp

ress

ant

Usua

lly U

ltra

Nard

ilPh

enel

zine

Depr

essio

nAn

tidep

ress

ant-M

AO In

ibito

rsOt

her t

han

Ultra

Nate

glin

ide

Nate

glin

ide

(NID

DM)

Antid

iabe

ticOt

her t

han

Ultra

Nava

neDe

pres

sion

Antip

sych

otic

Not I

nsur

able

Nave

lbin

eCa

ncer

Canc

erNo

t Ins

urab

leNe

docr

omil

Nedo

crom

ilRe

spira

tory

Antia

sthm

atic,

Alle

rgie

sUs

ually

Ultr

aNe

fazo

done

Nefa

zodo

neDe

pres

sion

Antid

epre

ssan

tOt

her t

han

Ultra

Neor

alCy

closp

orin

eAr

thrit

is, U

lcera

tive

Colit

isIm

mun

osup

pres

sant

Not I

nsur

able

Neos

arCy

cloph

osph

amid

eCa

ncer

, Rhe

umat

oid

Arth

ritis

Imm

unos

uppr

essa

ntNo

t Ins

urab

leNe

upog

enCa

ncer

Not I

nsur

able

Neur

ontin

Gaba

pent

inM

igra

ines

Antic

onvu

lsant

, Ana

lges

ic Ad

junc

tOt

her t

han

Ultra

Nexiu

mEs

omep

razo

leGa

stro

inte

stin

alAn

iulce

r Age

ntUs

ually

Ultr

aNi

a-Bi

dNi

acin

Hype

rcho

lest

erol

emia

, Sup

plem

ent

Lipid

-(fat

)-Low

erin

g dr

ug, V

itam

inUs

ually

Ultr

aNi

acNi

acin

Hype

rcho

lest

erol

emia

, Sup

plem

ent

Lipid

-(fat

)-Low

erin

g dr

ug, V

itam

inUs

ually

Ultr

aNi

acin

Niac

inHy

perc

hole

ster

olem

ia, S

uppl

emen

tLip

id-(f

at)-L

ower

ing

drug

, Vita

min

Usua

lly U

ltra

Niac

orNi

acin

Hype

rcho

lest

erol

emia

, Sup

plem

ent

Lipid

-(fat

)-Low

erin

g dr

ug, V

itam

inUs

ually

Ultr

aNi

aspa

nNi

acin

Hype

rcho

lest

erol

emia

, Sup

plem

ent

Lipid

-(fat

)-Low

erin

g dr

ug, V

itam

inUs

ually

Ultr

aNi

cobi

dNi

acin

Hype

rcho

lest

erol

emia

, Sup

plem

ent

Lipid

-(fat

)-Low

erin

g dr

ug, V

itam

inUs

ually

Ultr

aNi

cola

rNi

acin

Hype

rcho

lest

erol

emia

, Sup

plem

ent

Lipid

-(fat

)-Low

erin

g dr

ug, V

itam

inUs

ually

Ultr

aNi

cotin

exNi

acin

Hype

rcho

lest

erol

emia

, Sup

plem

ent

Lipid

-(fat

)-Low

erin

g dr

ug, V

itam

inUs

ually

Ultr

aNi

cotin

ic Ac

idNi

acin

Hype

rcho

lest

erol

emia

, Sup

plem

ent

Lipid

-(fat

)-Low

erin

g dr

ug, V

itam

inUs

ually

Ultr

aNi

togl

ycer

inNi

togl

ycer

inCa

rdia

c-Ni

trate

Anti-

Angi

nal

Othe

r tha

n Ul

traNi

trek

Nito

glyc

erin

Card

iac-

Nitra

teAn

ti-An

gina

lOt

her t

han

Ultra

Nitro

-Bid

Nito

glyc

erin

Card

iac-

Nitra

teAn

ti-An

gina

lOt

her t

han

Ultra

Nitro

cot

Nito

glyc

erin

Card

iac-

Nitra

teAn

ti-An

gina

lOt

her t

han

Ultra

Nitro

-Dur

Nito

glyc

erin

Card

iac-

Nitra

teAn

ti-An

gina

lOt

her t

han

Ultra

Nitro

glyn

E-R

Nito

glyc

erin

Card

iac-

Nitra

teAn

ti-An

gina

lOt

her t

han

Ultra

Nitro

lNi

togl

ycer

inCa

rdia

c-Ni

trate

Anti-

Angi

nal

Othe

r tha

n Ul

tra

FOR

PROD

UCER

USE

ON

LY. N

OT F

OR U

SE W

ITH

THE

PUBL

IC.

70

Drug

-Gen

eric

Ge

neric

Nam

eDe

scrip

tion/

Ther

apeu

tic C

lass

Prob

able

Act

ion

& T

rade

Nam

esCo

nditi

ons

Trea

ted

Nitro

-par

Nito

glyc

erin

Card

iac-

Nitra

teAn

ti-An

gina

lOt

her t

han

Ultra

Nitro

pres

sNi

tropr

ussid

eCa

rdia

cAn

tihyp

erte

nsive

Usua

lly U

ltra

Nitro

prus

side

Nitro

prus

side

Card

iac

Antih

yper

tens

iveUs

ually

Ultr

aNi

trost

atNi

togl

ycer

inCa

rdia

c-Ni

trate

Anti-

Angi

nal

Othe

r tha

n Ul

traNi

tro-T

ime

Nito

glyc

erin

Card

iac-

Nitra

teAn

ti-An

gina

lOt

her t

han

Ultra

Niza

tidin

eNi

zatid

ine

Gast

roin

test

inal

Antiu

lcer A

gent

Usua

lly U

ltra

Nizo

ral

Antif

unga

lUs

ually

Ultr

aNo

lvade

xBr

east

Can

cer

Othe

r tha

n Ul

traNo

rflex

Orph

enad

rine

Mus

cle S

pasm

sSk

elet

al M

uscle

Rel

axan

tOt

her t

han

Ultra

Norfr

anil

Imip

ram

ine

Depr

essio

nAn

tidep

ress

ant

Othe

r tha

n Ul

traNo

rpac

eDi

sopy

ram

ide

Card

iac

Antia

rrhyt

hmic

Othe

r tha

n Ul

traNo

rpra

min

Desip

ram

ine

Depr

essio

nAn

tidep

ress

ant

Othe

r tha

n Ul

traNo

rtrip

tylin

eDe

pres

sion

Othe

r tha

n Ul

traNo

rvas

cAm

lodi

pine

Card

iac-

Calci

um C

hann

el B

lock

erAn

tihyp

erte

nsive

Usua

lly U

ltra

Novo

-Flu

rpro

fen

Flurb

ipro

fen

Arth

ritis

NSAI

D, A

ntirh

eum

atic

Othe

r tha

n Ul

traNo

voHy

draz

ide

Hydr

ochl

orot

hiaz

ide

Card

iac,

Edem

aAn

tihyp

erte

nsive

, Diu

retic

Usua

lly U

ltra

NPH

Insu

linNP

H In

sulin

Diab

etes

, Ins

ulin

-Dep

ende

nt (I

DDM

)An

tidia

betic

Othe

r tha

n Ul

traNu

bain

Nalb

uphi

neNa

rcot

ic Pa

in M

edica

tion

Opio

id A

nalg

esic

Not I

nsur

able

Nu-D

iltia

zDi

ltiaz

emCa

rdia

c-Ca

lcium

Cha

nnel

Blo

cker

Antih

perte

nsive

sUs

ually

Ultr

aNu

Lev

Hyos

cyam

ine

Urin

ary,

Gast

roin

test

inal

Antis

pasm

odic,

Ant

ichol

iner

gic

Usua

lly U

ltra

Nupr

inIb

upro

fen

Arth

ritis,

Pai

nNS

AID

Othe

r tha

n Ul

traNu

-Sel

egili

neSe

legi

line

Park

inso

n’sAn

tipar

kinso

nNo

t Ins

urab

le

FOR

PROD

UCER

USE

ON

LY. N

OT F

OR U

SE W

ITH

THE

PUBL

IC.

71

Drug

-Gen

eric

Ge

neric

Nam

eDe

scrip

tion/

Ther

apeu

tic C

lass

Prob

able

Act

ion

& T

rade

Nam

esCo

nditi

ons

Trea

ted

OOc

tam

ide

Met

oclo

pram

ide

Gast

roin

test

inal

Antie

met

icUs

ually

Ultr

aOl

anza

pine

Olan

zapi

neSc

hizo

phre

nia,

Anr

oexia

Ner

vosa

Antip

sych

otic

Not I

nsur

able

Omep

razo

leOm

epra

zole

Gast

roin

test

inal

Aniu

lcer A

gent

Usua

lly U

ltra

Orap

Depr

essio

nAn

tipsy

chot

icNo

t Ins

urab

leOr

etic

Hydr

ochl

orot

hiaz

ide

Card

iac,

Edem

aAn

tihyp

erte

nsive

, Diu

retic

Usua

lly U

ltra

Orfro

Orph

enad

rine

Mus

cle S

pasm

sSk

elet

al M

uscle

Rel

axan

tOt

her t

han

Ultra

Orin

ase

Diab

etes

Anti

diab

etic

Othe

r tha

n Ul

traOr

phen

adrin

eOr

phen

adrin

eM

uscle

Spa

sms

Skel

etal

Mus

cle R

elax

ant

Othe

r tha

n Ul

traOr

phen

ate

Orph

enad

rine

Mus

cle S

pasm

sSk

elet

al M

uscle

Rel

axan

tOt

her t

han

Ultra

Orud

isKe

topr

ofen

Arth

ritis,

Pai

nNS

AID

Othe

r tha

n Ul

traOx

apro

zinOx

apro

zinAr

thrit

is, P

ain

NSAI

D, A

ntirh

eum

atic

Othe

r tha

n Ul

traOx

azep

amOx

azep

amAn

xiety

Antia

nxie

ty, S

edat

ive/H

ypno

ticOt

her t

han

Ultra

Oxca

rbaz

epin

eOx

carb

azep

ine

Seizu

re D

isord

erAn

ticon

vulsa

ntOt

her t

han

Ultra

Oxyb

utyn

inCo

ntin

ence

Othe

r tha

n Ul

traOx

ycod

one

Oxyc

odon

eNa

rcot

ic Pa

in M

edica

tion

Opio

id A

nalg

esic

Not I

nsur

able

Oxyc

ontin

Oxyc

odon

eNa

rcot

ic Pa

in M

edica

tion

Opio

id A

nalg

esic

Not I

nsur

able

PPa

cero

neAm

ioda

rone

Card

iac

Antia

rrhyt

hmics

Othe

r tha

n Ul

traPa

mel

orNo

rtrip

tylin

eDe

pres

sion

Antid

epre

ssan

tOt

her t

han

Ultra

Pam

idro

nate

Pam

idro

nate

Hype

rcal

cem

ia, P

aget

’sBo

ne R

esor

ptio

n In

hibi

tor

Othe

r tha

n Ul

traPa

rafo

n Fo

rteCh

lorzo

xazo

neM

uscle

Spa

sms

Skel

etal

Mus

cle R

elax

ant

Othe

r tha

n Ul

traPa

rlode

lBr

omoc

riptin

eFe

rtilit

yAn

tipar

kinso

nNo

t Ins

urab

lePa

rnat

eTr

anylc

ypro

min

eDe

pres

sion

Antid

epre

ssan

t-MAO

Inib

itors

Othe

r tha

n Ul

traPa

roxe

tine

Paro

xetin

eAn

xiety,

Dep

rssio

nAn

tianx

iety,

Ant

idep

ress

ant

Othe

r tha

n Ul

tra

FOR

PROD

UCER

USE

ON

LY. N

OT F

OR U

SE W

ITH

THE

PUBL

IC.

72

Drug

-Gen

eric

Ge

neric

Nam

eDe

scrip

tion/

Ther

apeu

tic C

lass

Prob

able

Act

ion

& T

rade

Nam

esCo

nditi

ons

Trea

ted

Paxil

Paro

xetin

eAn

xiety,

Dep

rssio

nAn

tianx

iety,

Ant

idep

ress

ant

Othe

r tha

n Ul

traPe

gano

neSe

izure

Diso

rder

Anti

seizu

reOt

her t

han

Ultra

Pem

olin

ePe

mol

ine

Stim

ulan

t, AD

HDCe

ntal

Ner

vous

Sys

tem

Stim

ulan

tUs

ually

Ultr

aPe

ntam

idin

eAI

DSAn

tiret

rovir

alNo

t Ins

urab

lePe

ntas

aM

esal

amin

eGa

stro

inte

stin

al-U

lcera

tive

Colit

isGI

Ant

iinfla

mm

ator

yOt

her t

han

Ultra

Pent

azin

ePr

omet

hazin

eAl

lerg

ies,

Seda

tion,

Nau

sea/

Vom

iting

Seda

tive/

Hypn

otic

Usua

lly U

ltra

Pepc

idTa

mot

idin

eGa

stro

inte

stin

alAn

iulce

r Age

ntUs

ually

Ultr

aPe

rcoc

etOx

ycod

one/

Acet

amin

ophe

nNa

rcot

ic Pa

in M

edica

tion

Opio

id A

nalg

esic

Call

Perc

odan

Oxyc

odon

e/As

pirin

Narc

otic

Pain

Med

icatio

nOp

ioid

Ana

lges

icCa

llPe

rgol

ide

Perg

olid

ePa

rkin

son’s

Antip

arkin

son

Not I

nsur

able

Perin

dopr

ilPe

rindo

pril

Card

iac

Antih

yper

tens

iveUs

ually

Ultr

aPe

ritra

teCa

rdia

cAn

ti an

gina

lOt

her t

han

Ultra

Perm

axPe

rgol

ide

Park

inso

n’sAn

tipar

kinso

nNo

t Ins

urab

lePe

rmiti

lDe

pres

sion

Antip

sych

otic

Not I

nsur

able

Pexe

vaDe

pres

sion

Antip

sych

otic

Not I

nsur

able

Phen

elzin

ePh

enel

zine

Depr

essio

nAn

tidep

ress

ant-M

AO In

ibito

rsOt

her t

han

Ultra

Phen

erga

nPr

omet

hazin

eAl

lerg

ies,

Seda

tion,

Nau

sea/

Vom

iting

Seda

tive/

Hypn

otic

Usua

lly U

ltra

Phen

ytoi

nPh

enyt

oin

Seizu

re D

isord

erAn

tiarry

thm

ic, A

ntico

nvul

sant

Othe

r tha

n Ul

traPh

ylloc

ontin

Amin

ophy

lline

Resp

irato

ryBr

onch

odila

tor

Othe

r tha

n Ul

traPi

loca

rpin

eGl

auco

ma

Usua

lly U

ltra

Pim

ecro

limus

Pim

ecro

limus

Derm

atiti

sTo

pica

l Im

mun

osup

pres

sant

Usua

lly U

ltra

Pind

olol

Visk

enCa

rdia

c- B

eta

Bloc

ker

Antih

yper

tens

iveUs

ually

Ultr

aPi

oglit

azon

ePi

oglit

azon

e(N

IDDM

)An

tidia

betic

Othe

r tha

n Ul

traPi

rbut

erol

Pirb

uter

olRe

spira

tory

Inha

ler

Bron

chod

ilato

rOt

her t

han

Ultra

Plaq

ueni

lHy

drox

ychl

oroq

uine

Rhem

atoi

d Ar

thrit

is, S

LEDM

ARD

Othe

r tha

n Ul

traPl

atin

olCa

ncer

Not I

nsur

able

Plav

ixAn

ticoa

gula

ntOt

her t

han

Ultra

Plen

dil

Felo

dipi

neCa

rdia

c-Ca

lcium

Cha

nnel

Blo

cker

Antia

ngin

al, A

ntih

yper

tens

iveOt

her t

han

Ultra

FOR

PROD

UCER

USE

ON

LY. N

OT F

OR U

SE W

ITH

THE

PUBL

IC.

73

Drug

-Gen

eric

Ge

neric

Nam

eDe

scrip

tion/

Ther

apeu

tic C

lass

Prob

able

Act

ion

& T

rade

Nam

esCo

nditi

ons

Trea

ted

Portl

acLa

ctul

ose

Gast

roin

test

inal

-Con

stip

atio

nLa

xativ

eUs

ually

Ultr

aPr

amip

exol

ePr

amip

exol

ePa

rkin

sons

Antip

arkin

son

Not I

nsur

able

Pran

din

Repa

glin

ide

(NID

DM)

Antid

iabe

ticOt

her t

han

Ultra

Prav

asta

tinPr

avas

tatin

Hype

rcho

lest

erol

emia

Lipid

-(fat

)-Low

erin

g dr

ugUs

ually

Ultr

aPr

azos

inPr

azos

inCa

rdia

c, Pr

osta

te E

nlar

gem

ent

Antih

yper

tens

ive, B

PHUs

ually

Ultr

aPr

ecos

eAc

arbo

se(N

IDDM

)An

tidia

betic

Othe

r tha

n Ul

traPr

edni

sone

Pred

niso

neSt

eroi

dAn

tiast

hmat

ic, C

ortic

oste

roid

Othe

r tha

n Ul

traPr

evac

idLa

nsop

razo

leGa

stro

inte

stin

al- U

lcer D

iseas

eAn

iulce

r Age

ntUs

ually

Ultr

aPr

eval

iteCh

oles

tyra

min

eHy

perc

hole

ster

olem

iaLip

id-(f

at)-L

ower

ing

drug

Usua

lly U

ltra

Prez

ista

HIV

Antir

etro

viral

Not I

nsur

able

Prilo

sec

Omep

razo

leGa

stro

inte

stin

alAn

iulce

r Age

ntUs

ually

Ultr

aPr

inivi

lLis

inop

rilCa

rdia

cAn

tihyp

erte

nsive

Usua

lly U

ltra

Prob

enec

idGo

utUs

ually

Ultr

aPr

ocan

bid

Proc

aina

mid

eCa

rdia

cAn

tiarrh

ythm

icsOt

her t

han

Ultra

Proc

ardi

aNi

fedi

pine

Card

iac-

Calci

um C

hann

el B

lock

erAn

tiang

inal

, Ant

ihpe

rtens

ives

Usua

lly U

ltra

Proc

ritEp

oetin

Anem

ia o

f Chr

onic

Rena

l Fai

lure

Anti-

anem

icNo

t Ins

urab

lePr

ogra

fTa

crol

imus

Dise

ases

Imm

unos

uppr

essa

ntNo

t Ins

urab

lePr

olixi

nFlu

phen

azin

ePs

ycho

ses

Antip

sych

otic

Not I

nsur

able

Pron

esty

lPr

ocai

nam

ide

Card

iac

Antia

rrhyt

hmics

Othe

r tha

n Ul

traPr

ostig

min

Mya

sthe

nia

Grav

isNo

t Ins

urab

lePr

oton

ixPa

ntop

razo

leGa

stro

inte

stin

alAn

iulce

r Age

ntUs

ually

Ultr

aPr

ovac

hol

Prav

asta

tinHy

perc

hole

ster

olem

iaLip

id-(f

at)-L

ower

ing

drug

Usua

lly U

ltra

Prov

entil

Albu

tero

lRe

spira

tory

Bron

chod

ilato

rOt

her t

han

Ultra

Prov

igil

Narc

olep

syOt

her t

han

Ultra

Proz

acFlu

oxet

ine

Depr

essio

nAn

tidep

ress

ant

Othe

r tha

n Ul

traPu

lmico

rtBu

deso

nide

Inha

ler

Resp

irato

ry In

hale

rCo

rtico

rste

roid

Inha

ler,

Antia

sthm

atic

Othe

r tha

n Ul

traPu

rinet

hol /

MP6

Canc

erNo

t Ins

urab

lePy

ridiu

mUr

inar

y-Bl

adde

rAn

ti bl

adde

r spa

smUs

ually

Ultr

a

FOR

PROD

UCER

USE

ON

LY. N

OT F

OR U

SE W

ITH

THE

PUBL

IC.

74

Drug

-Gen

eric

Ge

neric

Nam

eDe

scrip

tion/

Ther

apeu

tic C

lass

Prob

able

Act

ion

& T

rade

Nam

esCo

nditi

ons

Trea

ted

QQu

estra

nCh

oles

tyra

min

eHy

perc

hole

ster

olem

iaLip

id-(f

at)-L

ower

ing

drug

Usua

lly U

ltra

Quet

iapi

neQu

etia

pine

Schi

zoph

reni

aAn

tipsy

chot

icNo

t Ins

urab

leQu

ibro

n-T

Theo

phyll

ine

Resp

irato

ryBr

onch

odila

tor

Othe

r tha

n Ul

traQu

inal

anQu

inid

ine

Gluc

onat

eCa

rdia

cAn

tiarry

thm

icsOt

her t

han

Ultra

Quin

idin

eQu

inid

ine

Sulfa

teCa

rdia

cAn

tiarry

thm

icsOt

her t

han

Ultra

Quin

idin

e Gl

ucon

ate

Quin

idin

e Gl

ucon

ate

Card

iac

Antia

rryth

mics

Othe

r tha

n Ul

traQu

inid

ine

Sulfa

teQu

inid

ine

Sulfa

teCa

rdia

cAn

tiarry

thm

icsOt

her t

han

Ultra

RRa

loxif

ene

Ralo

xifen

eOs

teop

oros

isBo

ne R

esor

ptio

n In

hibi

tors

Othe

r tha

n Ul

traRa

mip

rilRa

mip

rilCa

rdia

cAn

tihyp

erte

nsive

Usua

lly U

ltra

Rane

xaCa

rdia

cAn

tiang

inal

Othe

r tha

n Ul

traRa

nitid

ine

Rani

tidin

eGa

stro

inte

stin

alAn

tiulce

r Age

ntUs

ually

Ultr

aRe

betro

nHe

patit

is C

Hept

itis

agen

tNo

t Ins

urab

leRe

glan

Met

oclo

pram

ide

Gast

roin

test

inal

Antie

met

icUs

ually

Ultr

aRe

gula

r Ins

ulin

Regu

lar I

nsul

inDi

abet

es, I

nsul

in-D

epen

dent

(IDD

M)

Antid

iabe

ticOt

her t

han

Ultra

Rela

fen

Nabu

met

one

Arth

ritis,

Pai

nNS

AID,

Ant

irheu

mat

icOt

her t

han

Ultra

Rela

xazo

neCh

lorzo

xazo

neM

uscle

Spa

sms

Skel

etal

Mus

cle R

elax

ant

Othe

r tha

n Ul

traRe

mer

onM

irtaz

apin

eDe

pres

sion

Antid

epre

ssan

tOt

her t

han

Ultra

Rem

icade

Infli

ximab

Rheu

mat

oid

Arth

ritis,

Cro

hn’s

DMAR

D, G

I Ant

iinfla

mm

ator

yOt

her t

han

Ultra

Rem

inyl

Gala

ntam

ine

Alzh

eim

ers/

Mem

ory

Anti-

Alzh

eirm

erNo

t Ins

urab

leRe

mul

arCh

lorzo

xazo

neM

uscle

Spa

sms

Skel

etal

Mus

cle R

elax

ant

Othe

r tha

n Ul

traRe

pagl

inid

eRe

pagl

inid

e(N

IDDM

)An

tidia

betic

Othe

r tha

n Ul

traRe

quip

Ropi

niro

lePa

rkin

sons

Antip

arkin

son

Not I

nsur

able

Resc

ripto

rDe

lavir

dine

HIV

Infe

ctio

nAn

tiret

rovir

alNo

t Ins

urab

le

FOR

PROD

UCER

USE

ON

LY. N

OT F

OR U

SE W

ITH

THE

PUBL

IC.

75

Drug

-Gen

eric

Ge

neric

Nam

eDe

scrip

tion/

Ther

apeu

tic C

lass

Prob

able

Act

ion

& T

rade

Nam

esCo

nditi

ons

Trea

ted

Rese

rpin

eCa

rdia

cOt

her t

han

Ultra

Resp

bid

Theo

phyll

ine

Resp

irato

ryBr

onch

odila

tor

Othe

r tha

n Ul

traRe

sper

idon

eRe

sper

idon

ePs

ycho

tic D

isord

ers

Antip

sych

otic

Not I

nsur

able

Rest

oril

Slee

ping

Pill

Usua

lly U

ltra

Retro

virAz

idot

hym

idin

eHI

V In

fect

ion

Antir

etro

viral

Not I

nsur

able

Rezu

linDi

abet

esOt

her t

han

Ultra

Rheu

mat

rex

Met

hotre

xate

Rheu

mat

oid

Arth

ritis

DMAR

D, Im

mun

osup

pres

sant

Othe

r tha

n Ul

traRi

daur

a (G

old)

Arth

ritis

Not I

nsur

able

Risp

erda

lRi

sper

idon

ePs

ycho

tic D

isord

ers

Antip

sych

otic

Not I

nsur

able

Risp

erid

one

Risp

erid

one

Psyc

hotic

Diso

rder

sAn

tipsy

chot

icNo

t Ins

urab

leRi

talin

Stim

ulan

tUs

ually

Ultr

aRi

tuxin

Canc

erNo

t Ins

urab

leRi

vast

igm

ine

Riva

stig

min

eAl

zhei

mer

s/M

emor

yAn

ti-Al

zhei

rmer

Not I

nsur

able

Riza

tript

anRi

zatri

ptan

Mig

rain

esVa

scul

ar H

eada

che

Supp

ress

ant

Usua

lly U

ltra

Roba

xinM

etho

carb

amol

Mus

cle S

pasm

sSk

elet

al M

uscle

Rel

axan

tOt

her t

han

Ultra

Rofe

coxib

Rofe

coxib

Arth

ritis

NSAI

DOt

her t

han

Ultra

Rofe

ron

Canc

erNo

t Ins

urab

leRo

pini

role

Ropi

niro

lePa

rkin

sons

Antip

arkin

son

Not I

nsur

able

Rosig

litaz

one

Rosig

litaz

one

(NID

DM)

Antid

iabe

ticOt

her t

han

Ultra

Row

asa

Mes

alam

ine

Gast

roin

test

inal

-Ulce

rativ

e Co

litis

GI A

ntiin

flam

mat

ory

Usua

lly U

ltra

Roxa

nol

Mor

phin

eNa

rcot

ic Pa

in M

edica

tion

Opio

id A

nalg

esic

Not I

nsur

able

Roxic

etOx

ycod

one/

Acet

amin

ophe

nNa

rcot

ic Pa

in M

edica

tion

Opio

id A

nalg

esic

Not I

nsur

able

Roxic

odon

eOx

ycod

one

Narc

otic

Pain

Med

icatio

nOp

ioid

Ana

lges

icNo

t Ins

urab

leRo

xiprin

Oxyc

odon

e/As

pirin

Narc

otic

Pain

Med

icatio

nOp

ioid

Ana

lges

icNo

t Ins

urab

leRu

bex

Doxo

rubi

cin H

ydro

chlo

ride

Canc

erAn

tineo

plas

ticNo

t Ins

urab

leRy

thm

odan

Diso

pyra

mid

eCa

rdia

cAn

tiarrh

ythm

icOt

her t

han

Ultra

Ryth

mol

Prop

afen

one

Card

iac

Antia

rrhyt

hmic

Othe

r tha

n Ul

tra

FOR

PROD

UCER

USE

ON

LY. N

OT F

OR U

SE W

ITH

THE

PUBL

IC.

76

Drug

-Gen

eric

Ge

neric

Nam

eDe

scrip

tion/

Ther

apeu

tic C

lass

Prob

able

Act

ion

& T

rade

Nam

esCo

nditi

ons

Trea

ted

SSa

lbut

amol

Albu

tero

lRe

spira

tory

Bron

chod

ilato

rOt

her t

han

Ultra

Salfl

exSa

lsala

teAr

thrit

is, P

ain

NSAI

DOt

her t

han

Ultra

Salg

esic

Salsa

late

Arth

ritis,

Pai

nNS

AID

Othe

r tha

n Ul

traSa

lmet

erol

Salm

eter

olRe

spira

tory

Inha

ler

Bron

chod

ilato

rOt

her t

han

Ultra

Sand

imm

une

Cyclo

spor

ine

Arth

ritis,

Ulce

rativ

e Co

litis

Imm

unos

uppr

essa

ntNo

t Ins

urab

leSa

quin

avir

HIV

Antir

etro

viral

Not I

nsur

able

Sara

fem

Fluox

etin

eDe

pres

sion

Antid

epre

ssan

tOt

her t

han

Ultra

Scop

alam

ine

Scop

alam

ine

Mot

ion

Sick

ness

(Tra

nsde

rmal

)An

item

etic

Usua

lly U

ltra

SD-D

epre

nyl

Sele

gilin

ePa

rkin

son’s

Antip

arkin

son

Not I

nsur

able

Sect

ral

Aceb

utol

olCa

rdia

c-Be

ta B

lock

erAn

tiarrh

ythm

ic, A

ntih

yper

tens

iveOt

her t

han

Ultra

Sele

gilin

eSe

legi

line

Park

inso

n’sAn

tipar

kinso

nNo

t Ins

urab

leSe

rax

Oxaz

epam

Anxie

tyAn

tianx

iety,

Sed

ative

/Hyp

notic

Othe

r tha

n Ul

traSe

reve

ntSa

lmet

erol

Resp

irato

ry In

hale

rBr

onch

odila

tor

Othe

r tha

n Ul

traSe

rlect

Depr

essio

nAn

tipsy

chot

icNo

t Ins

urab

leSe

roqu

elQu

etia

pine

Schi

zoph

reni

aAn

tipsy

chot

icNo

t Ins

urab

leSe

rtral

ine

Sertr

alin

eDe

pres

sion

Antid

epre

ssan

tOt

her t

han

Ultra

Serzo

neNe

fazo

done

Depr

essio

nAn

tidep

ress

ant

Othe

r tha

n Ul

traSi

mva

stat

inSi

mva

stat

inHy

perc

hole

ster

olem

iaLip

id-(f

at)-L

ower

ing

drug

Usua

lly U

ltra

Sine

met

Carb

idop

a/Le

vodo

paPa

rkin

son’s

, Use

d fo

r Res

tless

Leg

Antip

arkin

son

Not I

nsur

able

Sine

quan

Doxe

pin

Depr

essio

nAn

tianx

iety,

Ant

idep

ress

ant

Othe

r tha

n Ul

traSi

ngul

air

Mon

telu

kast

Resp

irato

ryBr

onch

odila

tor

Othe

r tha

n Ul

traSk

elax

inM

etax

alon

eM

uscle

Spa

sms

Skel

etal

Mus

cle R

elax

ant

Othe

r tha

n Ul

traSl

o-Ni

acin

Niac

inHy

perc

hole

ster

olem

ia, S

uppl

emen

tLip

id-(f

at)-L

ower

ing

drug

, Vita

min

Usua

lly U

ltra

Sola

raze

Declo

fena

cAr

thrit

isNS

AID

Othe

r tha

n Ul

traSo

lazin

eTr

ifluo

pera

zine

Antip

sych

otics

Antip

sych

otics

Not I

nsur

able

FOR

PROD

UCER

USE

ON

LY. N

OT F

OR U

SE W

ITH

THE

PUBL

IC.

77

Drug

-Gen

eric

Ge

neric

Nam

eDe

scrip

tion/

Ther

apeu

tic C

lass

Prob

able

Act

ion

& T

rade

Nam

esCo

nditi

ons

Trea

ted

Som

aCa

risop

rodo

lM

uscle

Spa

sms

Skel

etal

Mus

cle R

elax

ant

Othe

r tha

n Ul

traSo

rbitr

ate

Isoso

rbid

e Di

nitra

teCa

rdia

c-Ni

trate

Anti-

Angi

nal

Othe

r tha

n Ul

traSo

talo

lSo

talo

lCa

rdia

c-Be

ta B

lock

erAn

tiarrh

ythm

icOt

her t

han

Ultra

Spar

ine

Depr

essio

nAn

tipsy

chot

icNo

t Ins

urab

leSt

arlix

Nate

glin

ide

(NID

DM)

Antid

iabe

ticOt

her t

han

Ultra

Stel

azin

eTr

ifluo

pera

zine

Antip

sych

otics

Antip

sych

otics

Not I

nsur

able

Stra

ttera

Atte

ntio

n De

ficit

Diso

rder

Usua

lly U

ltra

Sulin

dac

Sulin

dac

Arth

ritis,

Pai

nNS

AID,

Ant

irheu

mat

icOt

her t

han

Ultra

Sum

atrip

tan

Sum

atrip

tan

Mig

rain

esVa

scul

ar H

eada

che

Supp

ress

ant

Usua

lly U

ltra

Sust

aire

Theo

phyll

ine

Resp

irato

ryBr

onch

odila

tor

Othe

r tha

n Ul

traSy

mm

etre

lAm

anta

dine

Park

inso

n’s, V

iral I

nfec

tions

Antip

arkin

son,

Ant

ivira

lNo

t Ins

urab

leSy

nthr

oid

Levo

thyr

oxin

eTh

yroi

d Pr

epar

atio

nsHo

rmon

eUs

ually

Ultr

a

TTa

ceCa

ncer

Not I

nsur

able

Tacr

ine

Tacr

ine

Mem

ory

Loss

Anti-

Alzh

eirm

erNo

t Ins

urab

leTa

crol

imus

Tacr

olim

usDi

seas

esIm

mun

osup

pres

sant

Not I

nsur

able

Taga

met

Cim

etid

ine

Gast

roin

test

inal

Antiu

lcer A

gent

Usua

lly U

ltra

Talw

inPe

ntaz

ocin

eNa

rcot

ic Pa

in M

edica

tion

Opio

id A

nalg

esic

Not I

nsur

able

Tam

boco

rFle

cain

ide

Card

iac

Antia

rrhyt

hmic

Othe

r tha

n Ul

traTa

mot

idin

eTa

mot

idin

eGa

stro

inte

stin

alAn

iulce

r Age

ntUs

ually

Ultr

aTa

mox

ifen

Brea

st C

ance

rOt

her t

han

Ultra

Tara

ctan

Antip

sych

otics

Not I

nsur

able

Taxo

lCa

ncer

Canc

erNo

t Ins

urab

leTe

gret

olCa

rbam

azep

ine

Neur

algi

aAn

ticon

vulsa

ntOt

her t

han

Ultra

Telm

isarta

nTe

lmisa

rtan

Hype

rtens

ion

Antih

yper

tens

iveUs

ually

Ultr

aTe

nex

Guan

facin

eCa

rdia

cAn

tihyp

erte

nsive

Usua

lly U

ltra

FOR

PROD

UCER

USE

ON

LY. N

OT F

OR U

SE W

ITH

THE

PUBL

IC.

78

Drug

-Gen

eric

Ge

neric

Nam

eDe

scrip

tion/

Ther

apeu

tic C

lass

Prob

able

Act

ion

& T

rade

Nam

esCo

nditi

ons

Trea

ted

Teno

retic

Card

iac

Antih

yper

tens

iveUs

ually

Ultr

aTe

norm

inCa

rdia

cAn

tihyp

erte

nsive

Usua

lly U

ltra

Tera

zosin

Tera

zosin

Card

iac,

Pros

tate

Enl

arge

men

tAn

tihyp

erte

nsive

, BPH

Usua

lly U

ltra

Terb

utal

ine

Terb

utal

ine

Resp

irato

ry In

hale

rBr

onch

odila

tor

Othe

r tha

n Ul

traTe

rfluz

ine

Trifl

uope

razin

eAn

tipsy

chot

icsAn

tipsy

chot

icsNo

t Ins

urab

leTe

vete

nEp

rosa

rtan

Card

iac

Antih

yper

tens

iveUs

ually

Ultr

aTh

eo-2

4Th

eoph

yllin

eRe

spira

tory

Bron

chod

ilato

rOt

her t

han

Ultra

Theo

bid

Theo

phyll

ine

Resp

irato

ryBr

onch

odila

tor

Othe

r tha

n Ul

traTh

eocle

arTh

eoph

yllin

eRe

spira

tory

Bron

chod

ilato

rOt

her t

han

Ultra

Theo

-Dur

Theo

phyll

ine

Resp

irato

ryBr

onch

odila

tor

Othe

r tha

n Ul

traTh

eola

irTh

eoph

yllin

eRe

spira

tory

Bron

chod

ilato

rOt

her t

han

Ultra

Theo

phyll

ine

Theo

phyll

ine

Resp

irato

ryBr

onch

odila

tor

Othe

r tha

n Ul

traTh

eosp

anTh

eoph

yllin

eRe

spira

tory

Bron

chod

ilato

rOt

her t

han

Ultra

Theo

vent

Theo

phyll

ine

Resp

irato

ryBr

onch

odila

tor

Othe

r tha

n Ul

traTh

iorid

azin

eTh

iorid

azin

eSc

hizo

phre

nia

Antip

sych

otic

Not I

nsur

able

Thor

azin

eCh

lorp

rom

azin

ePs

ycho

ses

Antip

sych

otics

, Ant

iem

etic

Not I

nsur

able

Thyr

arTh

yroi

dTh

yroi

d Pr

epar

atio

nsHo

rmon

eUs

ually

Ultr

aTh

yroi

dTh

yroi

dTh

yroi

d Pr

epar

atio

nsHo

rmon

eUs

ually

Ultr

aTh

yrol

arLio

trix

Thyr

oid

Prep

arat

ions

Horm

one

Usua

lly U

ltra

Tiam

ate

Dilti

azem

Card

iac-

Calci

um C

hann

el B

lock

erAn

tihpe

rtens

ives

Usua

lly U

ltra

Tiaza

cDi

ltiaz

emCa

rdia

c-Ca

lcium

Cha

nnel

Blo

cker

Antih

perte

nsive

sUs

ually

Ultr

aTig

anTr

imet

hobe

nzam

ide

Naus

ea a

nd V

omiti

ngAn

tiem

etics

Usua

lly U

ltra

Timol

ide

Com

boCa

rdia

cAn

tihyp

erte

nsive

Usua

lly U

ltra

Tipra

min

eIm

ipra

min

eDe

pres

sion

Antid

epre

ssan

tOt

her t

han

Ultra

Tirof

iban

Tirof

iban

Card

iac

Antip

late

let A

gent

Othe

r tha

n Ul

traTo

cain

ide

Toca

inid

eCa

rdia

cAn

tiarrh

ythm

icsOt

her t

han

Ultra

Tofra

nil

Imip

ram

ine

Depr

essio

nAn

tidep

ress

ant

Othe

r tha

n Ul

traTo

lbut

amid

eDi

abet

esAn

tidia

betic

Othe

r tha

n Ul

tra

FOR

PROD

UCER

USE

ON

LY. N

OT F

OR U

SE W

ITH

THE

PUBL

IC.

79

Drug

-Gen

eric

Ge

neric

Nam

eDe

scrip

tion/

Ther

apeu

tic C

lass

Prob

able

Act

ion

& T

rade

Nam

esCo

nditi

ons

Trea

ted

Tolca

pone

Park

inso

n’s D

iseas

eNo

t Ins

urab

leTo

lmet

inTo

lmet

inAr

thrit

is, P

ain

NSAI

D, A

ntirh

eum

atic

Othe

r tha

n Ul

traTo

ltero

dine

Tolte

rodi

neUr

inar

y-Bl

adde

rAn

ticho

liner

gic

Usua

lly U

ltra

Tono

card

Toca

inid

eCa

rdia

cAn

tiarrh

ythm

icsOt

her t

han

Ultra

Topa

max

Topi

ram

ate

Seizu

re D

isord

erAn

ticon

vulsa

ntOt

her t

han

Ultra

Topi

ram

ate

Topi

ram

ate

Seizu

re D

isord

erAn

ticon

vulsa

ntOt

her t

han

Ultra

Topr

olM

etop

rolo

lCa

rdia

cAn

tiang

inal

, Ant

ihyp

erte

nsive

Usua

lly U

ltra

Tora

dol

Arth

ritis

Othe

r tha

n Ul

traTo

rsem

ide

Tors

emid

eEd

ema

Diur

etic

Usua

lly U

ltra

Trac

leer

Bose

ntan

Card

iac

Pulm

onar

y hy

perte

nsio

nNo

t Ins

urab

leTr

ando

lapr

ilTr

ando

lapr

ilCa

rdia

cAn

tihyp

erte

nsive

Usua

lly U

ltra

Tran

sder

m-N

itro

Nito

glyc

erin

Card

iac-

Nitra

teAn

ti-An

gina

lOt

her t

han

Ultra

Tran

sder

m-S

cpSc

opal

amin

eM

otio

n Si

ckne

ss (T

rans

derm

al)

Anite

met

icUs

ually

Ultr

aTr

anxe

neAn

xiety

Othe

r tha

n Ul

traTr

anylc

ypro

min

eTr

anylc

ypro

min

eDe

pres

sion

Antid

epre

ssan

t-MAO

Inib

itors

Othe

r tha

n Ul

traTr

azad

one

Traz

odon

eDe

pres

sion

Antid

epre

ssan

tOt

her t

han

Ultra

Trex

all

Met

hotre

xate

Rheu

mat

oid

Arth

ritis

DMAR

D, Im

mun

osup

pres

sant

Othe

r tha

n Ul

traTr

ialo

dine

Traz

odon

eDe

pres

sion

Antid

epre

ssan

tOt

her t

han

Ultra

Tria

mcin

olon

e In

hale

rTr

iam

cinol

one

Inha

ler

Resp

irato

ry In

hale

rCo

rtico

rste

roid

Inha

ler,

Antia

sthm

atic

Othe

r tha

n Ul

traTr

iam

olon

eTr

iam

cinol

one

Ster

oid

Antia

sthm

atic,

Cor

ticos

tero

idOt

her t

han

Ultra

Tria

mte

rene

Tria

mte

rene

Edem

aDi

uret

ic, P

otas

sium

-Spa

ring

Usua

lly U

ltra

Tria

vilPe

rphe

nazin

e/Am

itrip

tylin

eDe

pres

sion

Othe

r tha

n Ul

traTr

icor

Feno

fibra

teHy

perc

hole

ster

olem

iaLip

id-(f

at)-L

ower

ing

drug

Usua

lly U

ltra

Trico

sal

Chol

ine/

Mag

nesiu

m S

alicy

late

Arth

ritis,

Pai

nNS

AID

Othe

r tha

n Ul

traTr

idil

Nito

glyc

erin

Card

iac-

Nitra

teAn

ti-An

gina

lOt

her t

han

Ultra

Trid

ione

Seizu

re D

isord

erOt

her t

han

Ultra

Trifl

uope

razin

eTr

ifluo

pera

zine

Antip

sych

otics

Antip

sych

otics

Not I

nsur

able

Trih

exan

eTr

ihex

yphe

nidy

lPa

rkin

son’s

Antip

arkin

son

Not I

nsur

able

FOR

PROD

UCER

USE

ON

LY. N

OT F

OR U

SE W

ITH

THE

PUBL

IC.

80

Drug

-Gen

eric

Ge

neric

Nam

eDe

scrip

tion/

Ther

apeu

tic C

lass

Prob

able

Act

ion

& T

rade

Nam

esCo

nditi

ons

Trea

ted

Trih

exyp

heni

dyl

Trih

exyp

heni

dyl

Park

inso

n’sAn

tipar

kinso

nNo

t Ins

urab

leTr

ilafo

nAn

tipsy

chot

icsNo

t Ins

urab

leTr

iiodo

thyr

onin

e Lio

thyr

onin

e Th

yroi

d Pr

epar

atio

ns

Horm

one

Usua

lly U

ltra

Trile

ptal

Oxca

rbaz

epin

eSe

izure

Diso

rder

Antic

onvu

lsant

Othe

r tha

n Ul

traTr

ilisa

teCh

olin

e/M

agne

sium

Sal

icyla

teAr

thrit

is, P

ain

NSAI

DOt

her t

han

Ultra

Trio

stat

Lioth

yron

ine

Thyr

oid

Prep

arat

ions

Horm

one

Usua

lly U

ltra

Trite

cRa

nitid

ine

Bism

uth

Citra

teGa

stro

inte

stin

alAn

tiulce

r Age

ntUs

ually

Ultr

aTr

uphy

lline

Amin

ophy

lline

Resp

irato

ryBr

onch

odila

tor

Othe

r tha

n Ul

traTy

lox

Oxyc

odon

e/Ac

etam

inop

hen

Narc

otic

Pain

Med

icatio

nOp

ioid

Ana

lges

icNo

t Ins

urab

leTy

sabr

iM

ultip

le S

clero

sisM

ultip

le S

clero

sisNo

t Ins

urab

le

UUl

tram

Narc

otic

pain

med

icatio

nNo

t Ins

urab

leUl

trazin

ePr

ochl

orpe

razin

ePs

ycho

ses

Antie

met

ic, A

ntip

sych

otic

Not I

nsur

able

Unip

hyl

Theo

phyll

ine

Resp

irato

ryBr

onch

odila

tor

Othe

r tha

n Ul

traUn

ivasc

Moe

xipril

Card

iac

Antih

yper

tens

iveUs

ually

Ultr

aUr

abet

hBe

than

ecol

Urin

ary-

Blad

der

Urin

ary

Trac

t Stim

ulan

tUs

ually

Ultr

aUr

echo

line

Beth

anec

olUr

inar

y-Bl

adde

rUr

inar

y Tr

act S

timul

ant

Usua

lly U

ltra

Urise

dUr

inar

y-Bl

adde

rUs

ually

Ultr

aUr

ispas

Urin

ary-

Blad

der

Usua

lly U

ltra

Urso

Cirrh

osis

Not I

nsur

able

VVa

ldec

oxib

Vald

ecox

ibAr

thrit

is, P

ain

NSAI

DOt

her t

han

Ultra

Valiu

mDi

azep

amRe

laxa

ntOt

her t

han

Ultra

Valp

roat

e So

dium

Valp

roat

e So

dium

Seizu

re D

isord

erAn

ticon

vulsa

nt, V

ascu

lar H

eada

ches

Othe

r tha

n Ul

tra

FOR

PROD

UCER

USE

ON

LY. N

OT F

OR U

SE W

ITH

THE

PUBL

IC.

81

Drug

-Gen

eric

Ge

neric

Nam

eDe

scrip

tion/

Ther

apeu

tic C

lass

Prob

able

Act

ion

& T

rade

Nam

esCo

nditi

ons

Trea

ted

Valp

roic

Acid

Valp

roic

Acid

Seizu

re D

isord

erAn

ticon

vulsa

nt, V

ascu

lar H

eada

ches

Othe

r tha

n Ul

traVa

lsarta

nVa

lsarta

nHy

perte

nsio

nAn

tihpe

rtens

iveUs

ually

Ultr

aVa

nado

mCa

risop

rodo

lM

uscle

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FOR

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82

Drug

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Ge

neric

Nam

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Prob

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otic

Not I

nsur

able

FOR

PROD

UCER

USE

ON

LY. N

OT F

OR U

SE W

ITH

THE

PUBL

IC.

83

Drug

-Gen

eric

Ge

neric

Nam

eDe

scrip

tion/

Ther

apeu

tic C

lass

Prob

able

Act

ion

& T

rade

Nam

esCo

nditi

ons

Trea

ted


84

Notes

Documents

General Guidelines - Resource Brokerage€¦ · 5’4 92-186 187-229 230-252 5’5 94-192 193-234 235-257 5’6 97-197 198-239 240-263 5’7 99-201 202-245 246-270 5’8 102-207 208-251