UCT Unacceptable Medications – Medicare Supplement
Applicants taking any of the medications listed below will be declined if they are not in the open enrollment
period. Do not submit their applications. This list is intended for use as a basic guide only. Due to the rapid
advances being made in the medical field, it is not possible to include all unacceptable medications or to keep
this list updated. UCT has the right to decline applications based on conditions indicated by other medications
that are not on this list. Contact the Customer Service Department at (800) 848-1124, ext. 300, or at
[email protected], with specific questions.
A
Abilify (Aripiprazole)
Abacavir (Ziagen)
Actraphane (Insulin)
Actrapid (Insulin)
Adriamycin (Doxorubicin)
Adrucil (Flourouracil)
Agenerase (Amprenavir)
Akineton (Biperiden)
Alfa Epogen (Epogen, Procrit,
Epoetin)
Alkeran (Melphalan)
Altretamine (Hexalen)
Amantadine (Symadine,
Symmetrel)
Ambenonium Chloride (Mytelase)
Amprenavir (Agenerase)
Anafranil (Clomipramine)
Anastrozole (Arimidex)
Antabuse (Disulfiram)
Arava(Leflunomide)
Aricept (Donepezil)
Arimidex (Anastrozole)
Aripiprazole (Abilify)
Aromasin (Exemestane) – taking
for 5 years
Arsenic Trioxide (Trisenox)
Artane (Trihexyphenidyl, Tremin)
Atamet (L-Dopa, Levodopa,
Sinemet)
Auranofin (Ridaura, Oral Gold)
Avinza (Morhine)
Avonex (Beta interferon,
Interferon Beta 1a, Rebif))
Azathioprine (Imuran)
Azidothymid (AZT)
Azmacort (Triamcinolone)
AZT (Azidothymid)
Azulfidine (Sulfasalazine)
B
Baclofen (Kemstro, Lioresal)
Baphen
Bendopa (Dopa, Levodopa)
Benztropine (Cogentin)
Beta interferon (Avonex,
Betaseron)
Betaseron (Beta interferon)
Bicalutamide (Casodex)
Biperiden (Akineton)
Blenoxane (Bleomycin)
Bleomycin (Blenoxane)
Bromocriptine (Parlodel)–if used
for Parkinson’s
Budesonide (Pulmicort)
Busulfan (Myleran)
Byetta
C
Calcimar (Calcitonin)
Calcitonin (Calcimar)
Capecitabine (Xeloda)
Carbidopa (Lodosyn)
Carbidopa-levidopa (Sinemet)
Casodex (Bicalutamide)
CeeNu (Lomustine)
Cellcept (Mycophenolate Mofetil)
Cerespan
Cerubidine (Daunorubicin)
Chlorambucil (Leukeran)
Chlorpromazine (Thorazine)
Cilostazol (Pletal)
Cisplatin (Platinol)
Clomipramine (Anafranil)
Clozapine (Clozaril)
Clozaril (Clozapine)
Cogentin (Benztropine)
Cognex (Tacrine)
Combivir (Zidovudine, Retrovir)
Copaxone (Glatiramer)
Compazine (Prochlorperazine)–if
used for psychotic disorders
Cortisone (Cortone)–if used for
arthritis or chronic lung
disorders
Cosmegan (Dactinomycin)
Crixivan (Indinavir)
Cyclophosphamide (Cytoxan,
Neosar)
Cycrimine (Pagitane)
Cycrimine Hydrochloride
(Kemadrin)
Cytarabine (Cytosar)
Cytosar (Cytarabine)
Cytoxan (Cyclophosphamide,
Neosar)
D
Dactinomycin (Cosmegan)
Dantrium (Dantrolene)
Dantrolene (Dantrium)
Daunorubicin (Cerubidine)
Deapril (Eegoloid Mesylates)
Delavirdine (Rescriptor)
Deponit (Minitran, Nitro Patch,
Nitroglycerin, Nitro-Dur,
Nitrostat)
Didanosine (Videx)
___________________________________________________________________________________________________________________________________
This list is not conclusive and is subject to change at any time without notice. We have the right to decline based on medications not on this list.
We do not take anyone using opiate medication(s).
Page 1
Rev. 12/13
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Didronel (Etidronate) if used for
Paget’s
Dihdroergotoxine (Niloric)
Disulfiram (Antabuse)
Dolophine (Methodone)
Donepezil (Aricept)
Dopar (Levadopa, Bendopa)
Doxil (Doxorubicin)
Doxorubicin (Adriamycin, Doxil,
Rubex)
Dronabinol (Marinol)
D4T (Stavudine, Zerit)
E
Edophonium Chlorides
Efavirenz (Sustiva)
Efudex (Fluoroplex, Fluorouracil)
Eldepryl (Selegiline)
Emcyt (Estramustine)
Enbrel (Etanercept)
Enlon (Reversol, Tensilon)
Epivir (Lamivudine)
Epoetin (Epogen, Procrit, Alfa
Epogen)
Epogen (Alfa epogen, Procrit)
Ergamisol (Levamisole)
Ergoloid Mesylates (Deapril)
Eskalith (Lithobid, Lithium)
Estramustine (Emcyt)
Etanercept (Enbrel)
Etidronate (Didronel) if used for
Paget’s
Etoposide (VePesid)
Eulexin (Flutamide)
Exelon (Rivastigmine)
Exemestane (Aromasin) taking for
5 years
F
Fareston (Toremifene)
Faslodex (Fulvestrant)
FDUR (Floxuridine, FUDR)
Femara (Letrozole)
Filgrastim (Neupogen)
Floxuridine (FUDR, FDUR)
Fluoroplex (Efudex, Fluorouracil)
Fluorouracil (Efudex, Fluoroplex)
Fluphenazine Hydrochloride
(Prolixin)
Flutamide (Eulexin)
Fluvoxamine (Luvox)
Fortovase (Invirase, Saquinavir)
Foscarnet (Foscavir)
Foscavir (Foscarnet)
FUDR (Floxuridine, FDUR)
Fulvestrant (Faslodex)
G
Galantamine (Razadyne, Reminyl)
Gallium Nitrate (Granite)
Ganite (Gallium Nitrate)
Gemtuzumab Ozogamicin
(Mylotarg)
Geodon (Ziprasidone)
Gerimal (Salac)
Glatiramer (Copaxone)
Gold Shots (Myochrysine)
Goserelin (Zoladex)
H
Haldol (Haloperidol)
Haloperidol (Haldol)
Herceptin (Trastuzumab)
Hexalen (Altretamine)
Hivid (Zalcitabine)
Humulin (Insulin)
Humalog (Insulin)
Hydergine (Ergoloid Mesylates)
Hydrea (Hydroxyurea)
Hydrochloride Pagitane
(Kemadrin, Procyclidine
Hydrochloride)
Hydrocortisone (Hydrocortone)–if
used for arthritis or chronic lung
disorders
Hydroxychloroquine (Plaquenil)
Hydroxyurea (Hydrea)
Hyoscyamine (Levsin, Levbid,
Levsinex) – if used for
Parkinson’s
Hypurin (Insulin)
I, J
Idamycin (Idarubicin)
Idarubicin (Idamycin)
Iletin (Insulin)
Imdur (Isobid, Isordil, Isosorbide)
Imuran (Azathioprine)
Indinavir (Crixivan)
Infliximab(Remicade)
Initard (Insulin)
Interferon Beta-1a (Avonex, Rebif)
Insulin (Actraphane, Actrapid,
Humulin, Humalog, Hypurin,
Iletin, Initard, Isophane,
Isulatard, Lantus, Lentard,
Lispro, Mixtard, Monotard,
Novolin, Protophane, Pur-In
Mix, PZI, Semitard, Ultralente,
Ultratard, Velosulin)
Intron
Invirase (Saquinavir, Fortovase)
Isobid (Imdur, Isordil, Isosorbide,)
Isordil (Imdur, Isobid, Isosorbide)
Isophane (Insulin)
Isosorbide (Imdur, Isordil, Isobid)
Isulatard (Insulin)
K
Kaletra (Lopinavir, Ritonavir,
Norvir)
Kemadrin (Procyclidine
Hydrochloride, Hydrochloride
Pagitane)
Kemstro (Baclofen, Lioresal)
L
Lamictal (Lamotrigine)
Lamivudine (Epivir)
Lamotrigine (Lamictal)
Lantus (Insulin)
Larodopa (L-dopa, Atamet,
Sinemet, Levodopa)
L-Dopa (Levodopa, Atamet,
Sinemet,
Larodopa)
Leflunomide(Arava)
Lentard (Insulin)
Letrozole (Femara)
Leukeran (Chlorambucil)
Leuprolide (Lupron)
___________________________________________________________________________________________________________________________________
This list is not conclusive and is subject to change at any time without notice. We have the right to decline based on medications not on this list.
We do not take anyone using opiate medication(s).
Page 2
Rev. 12/13
The Order of United Commercial Travelers of America
Levamisole (Ergamisol)
Laviamsole
Levbid (Hyoscyamine, Levsin,
Levsinex – if used for
Parkinson’s
Levodopa (Bendopa, Dopar)
Levsin (Levbid, Levsinex)
(Hyoscyamine)– if used for
Parkinson’s
Lioresal (Kemstro, Baclofen)
Lispro (Insulin)
Lithane (Lithium)
Lithium (Eskalith, Lithobid)
Lithobid (Eskalith, Lithium)
Lodosyn (Carbidopa)
Lomustine (CeeNu)
Lopinavir (Kaletra, Ritonavir,
Norvir)
Loxapine (Loxitane)
Loxitane (Loxapine)
Ludiomil (Maprotiline)
Lupron (Leuprolide)
Lusadril
Luvox (Fluvoxamine)
Lysodren (Mitotane)
M
Maprotiline (Ludiomil)
Marinol (Dronabinol)
Matulane (Procarbazine)
Mechlorethamine (Mustargen)
Megace (Megestrol)
Megestrol (Megace)
Mellaril (Thioridazine)
Melphalen (Alkeran)
Memantine Hydrochloride
(Namenda)
Mentane
Mercaptopurine (Purinethol)
Mesoridazine (Serentil)
Mestinon (Pyridostigmine)
Methadone (Dolophine)
Methdose
Methotrexate (Rheumatrex)
Mexate
Miacalcin (Calcitonin)–if used for
Paget’s
Minitran (Deponit, Nitro Dur,
Nitroglycerin, Nitro patch,
Nitrostat)
Mirapex (Pramipexole
Dihydrochloride)
Mithracin (Plicamycin)
Mitomycin (Mutamycin)
Mitotane (Lysodren)
Moban (Molindone)
Molindone (Moban)
Monotard (Insulin)
Morphine (Avinza)
Mustargen (Mechlorethamine)
Mutamycin (Mitomycin)
Myleran (Busulfan)
Mycophenlote Mofetil (Cellcept)
Mylotarg (Gemtuzumab
Ozogamicin)
Myochrysine (Gold Shots)
Mytelase (Ambenonium
Hydrochloride)
N
Namenda
Navane (Thiothixene)
Nebupent (Pentamidine, Pentam
300)
Nelfinavir (Viracept)
Neoscar (Cyclophamide, Cytoxan)
Neostigmine (Prostigmin)
Neupogen (Filgrastim)
Nevirapine (Viramune)
Nilandron (Nilutamide)
Niloric (Dihydroergotoxine)
Nilutamide (Nilandron)
Nitro-Dur (Deponit, Minitran,
Nitroglycerin, Nitro patch,
Nitrostat)
Nitroglycerin (Deponit, Minitran,
Nitro Dur, Nitro patch,
Nitrostat)
Nitro Patch (Deponit, Minitran,
Nitro-Dur, Nitroglycerin,
Nitrostat)
Nitrostat, (Deponit, Minitran, Nitro
Dur, Nitroglycerin, Nitro Patch)
Noloric
Nolvadex (Tamoxifen) taking for 5
years
Norvir (Ritonavir, Kaletra,
Lopinavir)
Novolin (Insulin)
O
Olanzapine (Zeprexa)
Oncovin (Vincristine)
Oral gold (Ridaura, Auranofin)
Oreton (Methyltestosterone)
Oxycodone (Oxycontin)
Oxycontin (Oxycondone)
Oxygen
P
Parlodel (Bromocriptine)–if used
for Parkinson’s
Parsidol–if used for Parkinson’s
Parsitan (Profenamine
Hydrochloride)
Pavabid
Pentam 300 (Nebupent,
Pentamidine)
Pentamidine (Nebupent, Pentam
300)
Pentoxifylline (Trental)
Pergolide (Permax)
Permax (Pergolide)
Perphenazine (Trilafon)
Platinol (Cisplatin)
Plaquenil (Hydroxchloroquine)
Pletal (Cilostazol)
Plicamycin (Mithracin)
Pramipexole Dihdrochloride
(Mirapex)
Prednisone–if used for arthritis or
chronic lung disorders
Procarbazine (Matulane)
Procrit (Epoetin Alfa Epogen,
Epogen)
Prochlorperazine (Compazine)–if
used for psychotic disorders
Procyclidine Hydrochloride
(Kemadrin, Hydrochloride
Pagitane)
Procrit (Alfa Epogen, Epogen)
___________________________________________________________________________________________________________________________________
This list is not conclusive and is subject to change at any time without notice. We have the right to decline based on medications not on this list.
We do not take anyone using opiate medication(s).
Page 3
Rev. 12/13
The Order of United Commercial Travelers of America
Profenamine Hydrochloride
(Parsitan)
Prolixin (Fluphenazine)
Prostigmin (Neostigmine)
Protophane (Insulin)
Pulmicort (Budesonide)
Purinethol (Mercaptopurine)
Pur-In Mix (Insulin)
Pyridostigmine (Mestinon)
PZI (Insulin)
Quetiapine (Seraquel)
Spiriva (Tiotropium, Tiotropium
Bromide)
Stavudine (D4T, Zerit)
Stelazine (Trifluoperazine)
Steroids
Stilbestrol
Stilphostrol
Sulfasalazine (Azulfidine)
Sustiva (Efavirenz)
Symadine (Amantadine,
Symmetrel)
Symmetrel (Amantadine,
Symadine)
R
T, U
Razadyne (Galantamine, Reminyl)
Rebif (Avonex, Interferon Beta 1a)
Remicade (Infliximab)
Reminyl (Galantamine, Razadyne)
Requip (Ropinirole Hydrochloride)
Rescriptor (Delavirdine)
Retrovir (Zidovudine, Combivir)
Reversol (Enlon, Tensilon)
Rheumatrex (Methotrexate)
Ridaura (Auranofin, Oral gold)
Rilutek (Riluzole)
Riluzole (Rilutek)
Risperdal (Risperidone)
Risperidone (Risperdal)
Ritonavir (Norvir, Kaletra,
Lopinavir)
Rivastigmine (Exelon)
Roferon (Wellferon)
Ropinirole Hydrochloride (Requip)
Rubex (Doxorubicin)
Tace
Tacrine (Cognex)
Tamoxifen (Nolvadex) – taking for
5 years
Tensilon (Enlon, Reversol)
Teslac (Testolactone)
Testolactone (Teslac)
Thalidomid T (Thalidomide)
Thalidomide (Thalidomid T)
Thioguanine
Thioplex (Thiotepa)
Thioridazine (Mellaril)
Thiotepa (Thioplex)
Thiothixene (Navane)
Thorazine (Chlorpromazine)
Ticlid
Tiotropium (Spiriva, Tiotropium
Bromide)
Tiotropium Bromide (Spiriva,
Tiotropium)
Toemifene (Fareston)
Trastuzumab (Herceptin)
Trelstar (Triptorelin)
Tremin (Trihexyphenidyl)
Trental (Pentoxifylline)
Triamcinolone (Azmacort)
Trifluoperazine (Stelazine)
Trihexyphenidyl (Artane, Tremin)
Trilafon (Perphenazine)
Triptorelin (Trelstar)
Trisenox (Arsenic Trioxide)
Tumor
Q
S
Salac (Gerimal)
Saquinavir (Fortovase, Invirase)
Selegiline (Eldepryl)
Semitard (Insulin)
Serentil (Mesoridazine)
Serdolect (Sertindole)
Serquel (Quetiapine)
Sertindole (Serdolect)
Sinemet (Carbidopa-Levidopa)
Sorbitrate (Isordil)
Tumor Necrosis Factor
Ultralente (Insulin)
Ultratard (Insulin)
V, W
Velarcrine Maleate
Velosulin (Insulin)
VePesid (Etoposide)
Videx (Didanosine)
Vincristine (Oncovin)
Viracept (Nelfinavir)
Viramune (Nevirapine)
X, Y
Xeloda (Capecitabine)
Xelods
Z
Zalcitabine (Hivid)
Zerit (D4T, Stavudine)
Ziagen (Abacavir)
Zidovudine (Combivir, Retrovir)
Ziprasidone (Geodon)
Zoladex (Goserelin)
Zyprexa (Olanzapine)
___________________________________________________________________________________________________________________________________
This list is not conclusive and is subject to change at any time without notice. We have the right to decline based on medications not on this list.
We do not take anyone using opiate medication(s).
Page 4
Rev. 12/13
The Order of United Commercial Travelers of America