NC North Carolina Affordable Health Insurance

USA Affordable Insurance
Plan Qualifier


Are you taking any of the medications below:  Please read through the list and answer below.

 

Prescription Drug Usage

Medication

Associated Medical Condition

AZT

HIV AIDS

Adriamycin

Cancer

Adruanycin

Cancer

Akineton

Parkinson's Disease

Alkeran

Cancer

Amantadine

Parkinson's Disease

Antabuse

Alcoholism

Aricept

Alzheimer's Disease/Dementia

Artane

Partinson's Disease

Carbidopa

Parkinson's Disease

CeeNu

Cancer, Hodgkin's

Cerespan

Dementia

Codeine

Pain

Congentin

Parkinson's Disease

Cosmegen

Cancer

Coumadin

Anticoagulation/Atrial Fibrillation/Heart Valve Disorder/Strokes and TIAs/Emboli

Cyclospasmol

Dementia/TIAs/Peripheral Vascular Disease

Cycloserine

Tuberculosis

Cytoxan

Cancer, Kidney Damage

Cytosar

Leukemia/Cancer

Cyclophosphamide

Cancer

Dantrium

Multiple Sclerosis/Neuro-Motor Disorders

Demerol

Pain

Depen

Wilson's Disease/Rheumatoid Arthritis

Deprenyl

Parkinson's Disease

Ditropan

Neurogenic Bladder

Diethylstilbestrol (DES)

Prostate and Breast Cancer

Dopar

Parkinson's Disease

Eldepryl

Parkinson's Disease

Epogen

Severe Anemia

Ergoloid

Alzheimer's Disease/Dementia/Small Strokes

Eulexin

Prostate Cancer

Etaposide

Cancer

Fludara

Leukemia/Cancer

Foscarnet

AIDS/ARC/CMV

Foscavir

AIDS/ARC/CMV

FUDR

Cancer

Gold Therapy

Rheumatoid Arthritis

Medication

Associated Medical Condition

Haldol

Psychosis

Heparin

Anticoagulation Therapy/Heart Attack/Stroke

Hydergine

Dementia/Strokes/Peripheral Vascular Disease

Insulin:Regular, NPH, Lente, Humalin, Humalog, Novolin

Diabetes

Isordil

Angina/Coronary Artery Disease

Kemadrin

Parkinson's Disease

Lanoxin

Arrhythmias/Heart Disease/Heart Failure

Laropoda

Parkinson's Disease

L-Dopa

Parkinson's Disease

Leukeran

Leukemia/Malignant Lymphoma/Cancer

Lithium

Bipolar Disorder/Manic Depressive Disorder

Lysodren

Cancer

Matulane

Hodgkin's Disease

Maxair

Asthma/COPD

Meclizine HCL

Dizziness/Vertigo

Megace

Anorexia/Cachexia/Weight Loss

Mellaril

Major Mental Disorders/Psychoses

Mentane

Alzheimer's

Mestinon

Myasthenia Gravis

Methotrexate

Rheumatoid Arthritis/Blood Disorders

Mithracin

Paget's Disease of Bone/Cancer of Testis

Moban

Psychosis/Mental Disorders

Molindone

Mental Disorders/Psychoses

Morphine

Severe Pain

Mustargen

Cancer/Leukemia

Mutamycin

Cancer

Myleran

Leukemia/Cancer

Mytelase

Myasthenia Gravis

Medication

Associated Medical Condition

Naltrexone

Chronic Alcoholism

Navane

Psychoses, Mental Disorders

Neurontin

Seizure Disorders/Epilepsy

Nitro-Bid

Angina/Healt Disease

Nitroglycerin

Angina/Chest Pain

Norpace

Arrhrythmias/Heart Disease

Oncovin

Cancer/Leukemia

Orap

Psychosis/Tourette's Disorder

Oxybutynin

Neurogenic Bladder

Pancrease

Chronic Pancreatitis/Cystic Fibrosis

Papaverine

Vasodilater/Increases Central Blood Supply

Parlodel

Parkinson's Disease

Parsidol

Parkinson's Disease

Pavabid

Stroke/Peripheral Vascular Disease/Dementia

Pentam

AIDS, ARC

Pentamidine

AIDS, ARC

Percodan

Pain

Permax

Parkinson's Disease

Persantine

Peripheral Vascular Disease/Heart Disease

Plaquenil

Lupus/Rheumatoid Arthritis

Plantinol

Cancer

Plavix

Stroke/Heart Attack

Procyclidine

Parkinson's Disease

Prostigmin

Myasthenia Gravis

Prolixin

Psychosis/Mental Disorders

Purinethol

Leukemia/Blood Disorders

Quinidine Sulfate

Arrhythmias/Heart Disease

Roferon-A

Hepatitis/AIDS/Leukemia

Retrovir

AIDS, ARC

Rheumatrex

Lupus, Scleroderma, Leukemia

Risperdal

Psychosis/Mental Disease

Sandimmune

Transplant Anti-Rejection

Serentil

Psychosis/Mental Disease

Seroquel

Psychosis/Mental Disease

Sinemet

Parkinson's Disease

Sparine

Psychosis/Mental Disease

Stelazine

Psychosis/Mental Disease

Symmetrel

Parkinson's Disease

Stilphostrol

Cancer

Synapton

Dementia

Tacrine

Dementia, Memory Loss/Alzheimer's Disease

Talwin

Pain

Medication

Associated Medical Condition

Tamoxifen

Breast Cancer

Taxol

Cancer

Thiotepa

Cancer

Thorazine

Psychosis/Mental Disease

Ticlid

Stroke/TIA/Cerebral Infarct

Trental

Claudication/Peripheral Vascular Disease

Termin

Parkinson's Disease

Transderm-Nitro

Angina/Heart Disease

Trilafon

Psychosis/Mental Disease

Tylox

Pain

Urecholine

Neurogenic Bladder

Valacrine Meletate

Alzheimer's

Vasodilon

Cerebral Vascular Insufficiency/PVD

Velban

Cancer/Hodgkin's Disease

Ventolin

Asthma, Respiratory Disease

Vespid

Cancer

Vercyte

Psychosis

Warfarin

Anticoagulation/Atrial Fibrillation/Emboli

Zoladex Implant

Prostate Cancer

Zyprexa

Psychotic Disorders/Mental Disease

Yes     No