Citi Benefits Handbook
Prescription Drug Benefits at a Glance
Beginning in 2018, if a multisource brand-name drug is dispensed rather than an available, chemically equivalent generic drug, you will pay the difference in cost between the brand-name and the generic drug in addition to your copay. This charge will be applied regardless of whether the doctor or you require the brand-name drug to be dispensed.
1 In the High Deductible Health Plan (HDHP), you must meet your combined medical/prescription drug deductible before the Program will pay benefits, except for certain preventive drugs. To determine whether your medication is considered preventive, visit www.express-scripts.com. Your cost for these preventive drugs is the applicable copay or coinsurance, which will count toward your out-of-pocket maximum.
2 Retail pharmacy purchases are not reimbursable under the Program after three refills of the same maintenance drug.
3 The use of generic equivalents whenever possible (through both the retail and Express Scripts Home Delivery programs) is more cost-effective. Ask your medical professional about this distinction. If you request a brand-name drug and a generic alternative is available, you will pay the difference between the cost of the brand-name drug and the generic drug in addition to the copay for the generic drug.
4 Citi does not determine preferred brand-name drugs. Rather, Express Scripts brings together an independent group of practicing physicians and pharmacists who meet quarterly to review the preferred brand-name formulary list and make determinations based on current clinical information. Call Express Scripts at 1 (800) 227-8338 or visit www.express-scripts.com for a copy of its Preferred Formulary (updated at least quarterly).
5 You are required to fill the prescription through Accredo. In the event of an emergency, please contact Express Scripts to fill the prescription. You will be charged only the applicable retail/specialty copay.
Note: For the ChoicePlan 500 and Oxford PPO, pharmacy and/or Express Scripts Home Delivery copays do not count toward your medical plan's annual deductible or out-of-pocket maximum, as there is a separate pharmacy deductible and a separate pharmacy out-of-pocket maximum.