Medications (MOO LP Level and Graded)
Last Modified on 04/05/2022 9:38 am CDT
Note: The following list is NOT all inclusive. If a drug is not listed that does not indicate that the drug will not trigger a Decline.
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| Drug | Omaha Graded Benefit | Omaha LP |
| Abacavir | Knockout
| Knockout |
| Abilify | May Qualify | Not a knockout, but additional info required to determine as to reason the PI is prescribed this medication.
|
| Alkeran | Knockout
| Knockout
|
| Aggrenox | Not a knockout, but additional info required to determine as to reason the PI is prescribed this medication.
| Not a knockout, but additional info required to determine as to reason the PI is prescribed this medication. |
| Amiodarone | May Qualify | Knockout
|
| Ampyra | May Qualify
| Knockout
|
| Anoro Ellipta | May Qualify
| Knockout |
| Antabuse | May Qualify
| Knockout
|
| Aricept | Knockout
| Knockout
|
| Arimidex | Not a knockout, but additional info required to determine as to reason the PI is prescribed this medication.
| Not a knockout, but additional info required to determine as to reason the PI is prescribed this medication.
|
| Atripla | Knockout
| Knockout
|
| Avonex | May Qualify
| Knockout
|
| Azilect | May Qualify
| Knockout
|
| Baraclude | Not a knockout, but additional info required to determine as to reason the PI is prescribed this medication.
| Not a knockout, but additional info required to determine as to reason the PI is prescribed this medication.
|
| Betaseron | May Qualify
| Knockout
|
| Calcium Acetate | May Qualify
| Knockout
|
| Campath | Knockout
| Knockout
|
| Campral | May Qualify
| Knockout
|
| Caprelsa | Knockout
| Knockout
|
| Carbidopa | May Qualify
| Knockout
|
| Carvedilol | Not a knockout, but additional info required to determine as to reason the PI is prescribed this medication.
| Not a knockout, but additional info required to determine as to reason the PI is prescribed this medication.
|
| Casodex | Knockout
| Knockout
|
| Cellcept | Knockout
| Knockout
|
| Clopidogrel | Not a knockout, but additional info required to determine as to reason the PI is prescribed this medication.
| Not a knockout, but additional info required to determine as to reason the PI is prescribed this medication.
|
| Chlorpromazine Hcl | May Qualify
| Knockout
|
| Clozapine | May Qualify
| Knockout
|
| Cognex | Knockout
| Knockout
|
| Combivir | Knockout
| Knockout
|
| Copaxone | May Qualify
| Knockout
|
| Coreg | Not a knockout, but additional info required to determine as to reason the PI is prescribed this medication.
| Not a knockout, but additional info required to determine as to reason the PI is prescribed this medication.
|
| Coumadin | Not a knockout, but additional info required to determine as to reason the PI is prescribed this medication.
| Not a knockout, but additional info required to determine as to reason the PI is prescribed this medication.
|
| Crixivan | Knockout
| Knockout
|
| Cyclosporine | Knockout
| Knockout
|
| Cytoxan | Knockout
| Knockout
|
| Daliresp | May Qualify | Knockout |
| Digitek | Not a knockout, but additional info required to determine as to reason the PI is prescribed this medication.
| Not a knockout, but additional info required to determine as to reason the PI is prescribed this medication.
|
| Digoxin | Not a knockout, but additional info required to determine as to reason the PI is prescribed this medication.
| Not a knockout, but additional info required to determine as to reason the PI is prescribed this medication.
|
| Donepezil | Knockout
| Knockout
|
| Droxia | Knockout
| Knockout
|
| Eligard | Knockout
| Knockout
|
| Eliquis | Not a knockout, but additional info required to determine as to reason the PI is prescribed this medication.
| Not a knockout, but additional info required to determine as to reason the PI is prescribed this medication.
|
| Eminase | Knockout
| Knockout
|
| Enoxaparin Sodium | Not a knockout, but additional info required to determine as to reason the PI is prescribed this medication.
| Not a knockout, but additional info required to determine as to reason the PI is prescribed this medication.
|
| Epivir Hbv | Knockout
| Knockout
|
| Ergoloid Mesylates | Knockout
| Knockout
|
| Exelon | Knockout
| Knockout
|
| Femara | Not a knockout, but additional info required to determine as to reason the PI is prescribed this medication.
| Not a knockout, but additional info required to determine as to reason the PI is prescribed this medication.
|
| Floxuridine | Knockout
| Knockout
|
| Fluorouracil | Knockout
| Knockout
|
| Galantamine Hydrobromide | Knockout
| Knockout
|
| Gammagard | Knockout
| Knockout |
| Gamunex | Knockout
| Knockout
|
| Gengraf | Knockout
| Knockout
|
| Geodon | May Qualify
| Knockout
|
| Haldol | May Qualify
| Knockout
|
| Haloperidol | May Qualify
| Knockout
|
| Hydrea | Knockout
| Knockout
|
| Hydroxyurea | Knockout
| Knockout
|
| Infergen | Knockout
| Knockout
|
| Invega | May Qualify
| Knockout
|
| Invirase | Knockout
| Knockout
|
| Isentress | Knockout
| Knockout
|
| Keytruda | Knockout
| Knockout
|
| Lanoxin | Not a knockout, but additional info required to determine as to reason the PI is prescribed this medication.
| Not a knockout, but additional info required to determine as to reason the PI is prescribed this medication.
|
| Latuda | May Qualify
| Knockout
|
| Leucovorin Calcium | Knockout
| Knockout
|
| Lexiva | Knockout
| Knockout
|
| Limbitrol | Knockout
| Knockout
|
| Lithium | May Qualify
| Knockout
|
| Lovenox | Not a knockout, but additional info required to determine as to reason the PI is prescribed this medication.
| Not a knockout, but additional info required to determine as to reason the PI is prescribed this medication.
|
| Megace | Knockout
| Knockout
|
| Megestrol Acetate (Megace) | Knockout
| Knockout
|
| Mitomycin | Knockout
| Knockout
|
| Mycophenolate | Knockout
| Knockout
|
Mofetil
| Knockout
| Knockout
|
| Myfortic | Knockout
| Knockout
|
| Naloxone Hcl | May Qualify
| Knockout
|
| Naltrexone Hcl | May Qualify
| Knockout
|
| Namenda | Knockout
| Knockout
|
| Neupogen | Knockout
| Knockout
|
| Opdivo | Knockout
| Knockout |
| Panretin | Knockout
| Knockout
|
| Pegasys | Not a knockout, but additional info required to determine as to reason the PI is prescribed this medication.
| Not a knockout, but additional info required to determine as to reason the PI is prescribed this medication.
|
| Peg-Intron | Not a knockout, but additional info required to determine as to reason the PI is prescribed this medication.
| Not a knockout, but additional info required to determine as to reason the PI is prescribed this medication.
|
| Perphenazine | May Qualify
| Knockout
|
| Plavix | Not a knockout, but additional info required to determine as to reason the PI is prescribed this medication.
| Not a knockout, but additional info required to determine as to reason the PI is prescribed this medication.
|
| Pradaxa | Not a knockout, but additional info required to determine as to reason the PI is prescribed this medication.
| Not a knockout, but additional info required to determine as to reason the PI is prescribed this medication.
|
| Prograf | Knockout
| Knockout
|
| Ranexa | May Qualify
| Knockout
|
| Razadyne | Knockout
| Knockout
|
| Rebif | May Qualify
| Knockout
|
| Retrovir | Knockout
| Knockout
|
| Revia | May Qualify
| Knockout
|
| Revlimid | Knockout
| Knockout
|
| Ribavirin | May Qualify
| Knockout
|
| Risperdal | May Qualify
| Knockout
|
| Rituxan | Knockout
| Knockout
|
| Sandimmune | Knockout
| Knockout
|
| Saphris | May Qualify
| Knockout
|
| Seroquel | Not a knockout, but additional info required to determine as to reason the PI is prescribed this medication.
| Not a knockout, but additional info required to determine as to reason the PI is prescribed this medication.
|
| Serzone | Knockout
| Knockout
|
| Sinemet | May Qualify
| Knockout
|
| Spiriva | May Qualify
| Knockout
|
| Stalevo | May Qualify
| Knockout
|
| Stribild | Knockout
| Knockout
|
| Suboxone | May Qualify
| Knockout
|
| Sustiva | Knockout
| Knockout
|
| Symbyax | May Qualify
| Knockout
|
| Tamoxifen | Not a knockout, but additional info required to determine as to reason the PI is prescribed this medication.
| Not a knockout, but additional info required to determine as to reason the PI is prescribed this medication.
|
| Targretin | Knockout
| Knockout
|
| Teslac | Knockout
| Knockout
|
| Truvada | Not a knockout, but additional info required to determine as to reason the PI is prescribed this medication.
| Not a knockout, but additional info required to determine as to reason the PI is prescribed this medication.
|
| Tudorza | May Qualify | Knockout |
| Viracept | Knockout
| Knockout
|
| Viramune | Knockout
| Knockout
|
| Viread | Knockout
| Knockout
|
| Warfarin | Not a knockout, but additional info required to determine as to reason the PI is prescribed this medication.
| Not a knockout, but additional info required to determine as to reason the PI is prescribed this medication.
|
| Xarelto | Not a knockout, but additional info required to determine as to reason the PI is prescribed this medication.
| Not a knockout, but additional info required to determine as to reason the PI is prescribed this medication.
|
| Zenapax | Knockout
| Knockout
|
| Zerit | Knockout
| Knockout
|
| Ziagen | Knockout
| Knockout
|
| Zidovudine | Knockout
| Knockout
|
| Zoladex | Knockout
| Knockout
|
| Zyprexa | May Qualify
| Knockout
|
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