Citi Benefits Handbook
Prior Authorization with Express Scripts
To purchase certain medications or to receive more than an allowable quantity of some medications, your pharmacist must receive prior authorization from Express Scripts before these drugs will be covered under the Citigroup Prescription Drug Program.
- Examples of medications requiring "prior authorization" are Retin-A cream, growth hormones, anti-obesity medications, rheumatoid arthritis medications, and Botox.
- Examples of medications whose quantity will be limited are smoking cessation products, migraine medications, and erectile dysfunction medications.
Other medications, such as certain non-steroidal anti-inflammatories, will be covered only in situations where a lower-cost alternative medication is not appropriate.
To determine if your medication requires a prior authorization or is subject to a quantity limit, call Express Scripts at 1 (800) 227-8338 or visit the Express Scripts website at www.express-scripts.com. Your pharmacist can also determine if a prior authorization is required or a quantity limit will be exceeded at the time your prescription is dispensed.
If a review is required, you or your pharmacist can ask your physician to initiate a review by calling 1 (800) 224-5498. After your physician provides the required information, Express Scripts will review your case, which typically takes one to two business days. Once the review is completed, Express Scripts will notify you and your physician of its decision.
If your medication or the requested quantity is not approved for coverage under the Citigroup Prescription Drug Program, you can purchase the drug at its full cost to you.
Medication Review with Express Scripts
Under certain circumstances, you and your physician may request that Express Scripts perform a medical review of your medications. For additional information and instructions on how your physician can request a review, call Express Scripts at 1 (800) 227-8338.