61 Prescription Drugs Exclud ed from Coverage No charges will be paid for any Prescription Drug that is listed as a Medical Exclusion, or for any items in the list that follows: 1. Physician charges for administration or injection of any drug or medicine. 2. Biological serums, bloo d products, and allergy serums. 3. Cosmetic products including, but not limited to, anti - wrinkle agents; Botox Cosmetic, hair growth stimulants and hair removal agents; and similar items. However, retinoid medications are covered for treatment of acne for parti cipant s through age 25. 4. Devices and supplies of any type including, but not limited to, elastic bandages and supports; ostomy and irrigation supplies; hypodermic needles and syringes; nebulizers; and similar items. Note: The Plan covers insulin needles and syringes; and lancets and test strips for use with glucose testing devices described in the Diabetic Testing Equipment paragraph noted earlier in this section . 5. Drugs or medicines prescribed to be taken by, or administered to, the covered individual, in whole or in part, when the covered individual is a patient in an acute care hospital. 6. Male Androgens that are not approved as medically necessary by CVS Caremark . 7. Medications approved as medically necessary for the treatment of erectile dysfunction that ex ceed a 10 - pill per month limit for on demand products, or a 30 - pill per month limit for daily use of Cialis 2.5 mg or 5 mg. 8. Drug s for treatment of infertility. 9. Experimental drugs or drugs that are labeled: “Caution – limited by feder al law to investigation al use”. 10. Medications lawfully obtainable over - the - counter, medications not requiring a prescription from a physician, and any medication that is equivalent to an over - the - counter medication (except where federal law requires that certain over - the - counter m edication s be covered when prescribed). 11. Non - legend drugs other than insulin (except where required by federal law). 12. Refills that are in excess of the number prescribed by the physician or Allied Health Professional, or that are dispensed more than one yea r after the health care provider’s order. 13. Specialty Medications that are not approved for coverage under the guidelines for the CVS Caremark Specialty Guideline Management program. 14. Prescription drugs that are not included for coverage on the CVS Caremark formulary on the date the prescription is filled, or that are excluded from the formulary in favor of therapeutic equivalents (unless approved under the CVS Caremark review option). Benefits after Termination of Coverage The Prescription Drug Coverage will cease upon termination from the Plan, and no prescription drug benefits are available after termination, even if you are on an extension of medical benefits. If you anticipate your coverage will be ending, you should fill any needed prescriptions before y our termination date, or you will be asked to reimburse the Plan for any medication filled after your termination. If you use the mail order program, be sure to order refills so they are received before your termination date.