Form No. B2-783 Rev. 3/2011

661 East Davis Street, Elba, AL 36323

Drugs prescribed for uninsurable conditions If the applicant is taking one of these drugs, he/she is NOT eligible for any life coverage.

Drug Name

Generic Name Condition Treated Abacavir AIDS/HIV-1 infection Adrucil Fluorouracil Cancer Agenerase Amprenavir AIDS/ HIV-1 infection Aldactone Spironolactone Cirrhosis and heart failure Alferon N Interferon Alfa Cancer and Leukemia Alkeran Melphalan Cancer, leukemia, melanoma, brain tumor

Aloxi Palonosetron altretamine Cancer

Altretamine Cancer, leukemia, melanoma, brain tumor Amiloride Midamor Congestive heart failure Anastrozole Cancer, leukemia, melanoma, brain tumor Aranesp Darbepoetin alfa Kidney Failure (Dialysis patients) -(Chemo Patients) Aricept Donepezil Alzheimer's, Dementia Arimidex Anastrozole Cancer, leukemia, melanoma, brain tumor Asparaginase Cancer, leukemia, melanoma, brain tumor Atripla HIV

AZT Retrovir, Apo-zidovudine HIV

Basilixmab Kidney Failure, Renal insufficiency, Kidney Transplant

Betaserone Interferon Cancer Bexarotene Targretin Cancer, leukemia, melanoma, brain tumor Bexxar Tositumomab Cancer, leukemia, melanoma, brain tumor BICNU Carmustine Cancer, leukemia, melanoma, brain tumor Blenoxane Bleomycin Cancer, leukemia, melanoma, brain tumor Bleomycin Cancer, leukemia, melanoma, brain tumor Bortezomib Velcade Cancer Busulfan Cancer, leukemia, melanoma, brain tumor Busulfex Bulsulfan Cancer, leukemia, melanoma, brain tumor Camptosar Irinotecan Cancer - colon or rectal Carboplatin Cancer, leukemia, melanoma, brain tumor Carmustine Cancer, leukemia, melanoma, brain tumor Carvedilol Congestive Heart Failure CeeNU Lomustine Cancer, leukemia, melanoma, brain tumor Cedilanid Deslanoside Congestive Heart Failure

Form No. B2-783 Rev. 3/2011

Cerubidine Daunorubicin Cancer, leukemia, melanoma, brain tumor Chlorambucil Cancer, leukemia, melanoma, brain tumor Cisplatin Cancer, leukemia, melanoma, brain tumor Cladribine Leukemia/ Multiple sclerosis Cognex Tacrine Alzheimer's, Dementia Combivar Zidovudine/Lamivudine HIV/ Liver Disease including cirrhosis Copegus Ribavirin Liver Disease including Cirrhosis Coreg Carvedilol Congestive heart failure Cosmegan Dactinomycin Cancer, leukemia, melanoma, brain tumor Crixivan Indinavir AIDS/ HIV-1 infection Crystodigin Digitalis Congestive Heart Failure Cyclosphos-phamide Cancer Cytarabine Cancer, leukemia, melanoma, brain tumor Cytosar Cytarabine Cancer, leukemia, melanoma, brain tumor Cytoxan Cancer, leukemia, melanoma, brain tumor Dacarbazine Cancer, leukemia, melanoma, brain tumor

Dactinomycin Daunoxome Cancer, leukemia, melanoma, brain tumor

Darbepoetin alfa Kidney Failure Daunorubicin Cancer, leukemia, melanoma, brain tumor Delavirdine AIDS/HIV-1 infection Demadex Torsemide Congestive heart failure Denileukin Diftitox Cancer Deslanoside Congestive heart failure Dexrazoxane Cancer Didanosine AIDS/HIV-1 infection Digifortis Congestive heart failure Digiglusin Congestive heart failure Digitalis Congestive heart failure Digitoxin Congestive heart failure Digoxin Lanoxin Congestive heart failure Docetaxel Cancer Donepezil Aricept Alzheimers, Dementia Doxorubicin Cancer, leukemia, melanoma, brain tumor DTIC Dacarbazine Cancer Dyrenium Triamterene Congestive heart failure Edecrin Congestive heart failure, cancer Efavirenz Sustiva AIDS/HIV-1 infection Elitek Rasburicase Cancer Ellence Epirubicin Cancer Eloxatin Oxaliplatin Cancer, leukemia, melanoma, brain tumor Elspar Asparaginase Cancer, leukemia, melanoma, brain tumor Emcyt Estramustine Cancer Epirubicin Cancer Epivir Lamivudine AIDS/HIV-1 infection

Form No. B2-783 Rev. 3/2011

Epoetin alfa Kidney failure, Cancer, HIV infections Ergamisol Levamisole Cancer Erlotinib Cancer Estramustine Cancer Ethacrynic-acid Congestive heart failure Etopophos Etoposide phosphate Cancer Eulexin Flutamide Cancer Exelon Rivastigmine Alzheimers/Dementia Fareston Toremifene Cancer Femara Letrozole Cancer Flourouracil Cancer Fortovase,Invirase Saquinavir AIDS/HIV-1 infection Fludara Fludarabine Cancer Fludarabine Cancer 5-fluorour-acil Cancer Flutamide Cancer Furosemide Congestive Heart Failure Galantamine Alzheimers Gemcitabine Cancer Gemzar Gemcitabine Cancer Gleevac Imatinib Cancer, leukemia, melanoma, brain tumor Giliadel Carmustine Cancer, leukemia, melanoma, brain tumor Goserelin Cancer Herceptin Trastuzumab Cancer Hexalen Cancer, leukemia, melanoma, brain tumor Hivid Zalcitabine AIDS/HIV-1 infection Hycamtin Topotecan Cancer Hydrea Hydroxyura Cancer Hydroxyura Cancer Ifex Ifosfamide Cancer Ifosfamide Cancer Imatinib Cancer Iomustine Cancer, leuke Infergen Interferon alfacon-1 Liver disease including Cirrhosis Interferon Bataserone Cancer Interferon alfa Liver disease including Cirrhosis Intron-A Interferon alfa-2b Cancer Invirase Saquinavir AIDS/HIV-1 infrection Irinotecan Cancer Kaletra Lopinavir/Ritonavir AIDS/HIV-1 infection

Lamivudine AIDS/HIV-1 infection/ Liver disease including Cirrhosis

Iamivudine+ zidovudine AIDS/HIV-1 infection Lanoxin Digoxin Congestive Heart Failure Lasix Furosemide Congestive Heart Failure Letrozole Cancer

Form No. B2-783 Rev. 3/2011

Leukeran Chlorambucil Cancer Levamisole Cancer Leuprolide Lupron Cancer Leustatin Cladribine Cancer Lomustine Cancer Lupron Leuprolide Cancer Lysodren Mitatane Cancer Matulane Procarbazine Cancer Mechlore-Thiamine Cancer Medamex Congestive Heart Failure Megace Megestrol Cancer/AIDS Megestrol Cancer/AIDS Melphalan Cancer Memantine Alzheimer's/ Dementia 6-mercapto-purine Cancer Methotrexate Cancer Mithracin Plicamycin Cancer MitomycinC Cancer Mitotane Cancer Mitoxantrone Cancer MTX Methotrexate Cancer Mustargen Mechlore-Thiamine Cancer Mutamycin Mytomycin Cancer Myleran Busulfan, Busulfex Cancer Namenda Memantine Alzheimer's/Dementia Navelbine Vinorelbine Cancer Nelfinavir AIDS/HIV-1 infection Neosar Cyclophosphamide Cancer Neupogen Filgrastim Cancer Nevirapine Viramune AIDS/ HIV-1 infection Nolvadex Tamoxifen Cancer Norvir Ritonavir AIDS/ HIV-1 injection Novatrone Mitoxantrone Cancer Oncaspar Pegaspargase Cancer Onconvin Vincristine Cancer Ondansetron Caner Ontak Denileukin Diftitox Cancer Oxaliplatin Cancer Paclitaxel Cancer Palonosetron altretamine Cancer Paraplatin Carboplatin Cancer Pegaspargase Cancer Platinol Cisplatin Cancer Plicamycin Cancer Procarbazine Cancer

Form No. B2-783 Rev. 3/2011

Procrit Epoetin Alfa Kidney Failure, Cancer Purinethol Mercaptopurine Cancer, leukemia Purodigin Congestive Heart Failure Rasburicase Cancer Razadyne Galantamine Alzheimer's Rebetron Liver disease including Cirrhosis Reminyl Galantamine Alzheimer's/Dementia Renegal Sevelamer Kidney Failure Rescriotor Delavirdine AIDS/ HIV-1 infection Retrovir Zidovudine (AZT) AIDS/ HIV-1 infection Rheumatrex Methotrexate Cancer Ribavirin Liver disease including Cirrhosis Ritonavir AIDS/ HIV-1 infection Ritonavir-lopinavir AIDS/ HIV-1 infection Rituxan Rituximab Cancer Rituximab Cancer Rivastigmine Alzheimer disease/Dementia Roferon-A Interferon alfa-2A Cancer, Leukemia Saquinavir AIDS/ HIV-1 infection Sevelamer Kidney Failure Spironolactone Cirrhosis and heart failure Stavudine AIDS/ HIV-1 infection Sustiva Efavirenz AIDS/ HIV-1 infection Synapton Dementia Tace Cancer Tacrine Alzheimers/Dementia Tamoxifen Cancer Tarceva Erlotinib Cancer Targretin Cancer Taxol Paclitaxel Cancer Taxotere Docetaxel Cancer Tenofovir AIDS/HIV-1 infection Teslac Testolactone Cancer 6-thioguanine Cancer Thioplex Thiotepa Cancer Thiotepa Cancer Topotecan Cancer Toremifene Cancer Torsemide Congestive heart failure Tositumomab Cancer Trastuzumab Cancer Triamterene Congestive heart failure Trexall Methotrexate Cancer Trisenox Cancer Valsartan Congestive heart failur Velban Vinblastine Cancer

Form No. B2-783 Rev. 3/2011

Velcade Bortizomib Cancer VePesid Cancer Videx Didanosine AIDS/ HIV-1 infection Vinblastine Cancer Vincristine Cancer Viracept Nelfinavir AIDS/ HIV-1 infection Viramune AIDS/ HIV- 1 infection Viread Tenofovir AIDS/ HIV- 1 infection Wellferon AIDS/ HIV- 1 infection Zalcitabine AIDS/ HIV- 1 infection Zerit Stavudine AIDS/ HIV- 1 infection Ziagen Abacavir AIDS/ HIV-1 infection

Zidovudine (AZT) Retrovir, Apo-zidovudine AIDS/ HIV-1 infection

Zinecard Dexrazoxane Cancer Zofran Ondansetron Cancer Zoladex Goserelin Cancer