Citi Benefits Handbook
Covered Drugs
The following drugs and products are covered under the Citigroup Prescription Drug Program:
  • Federal legend drugs;
  • State-restricted drugs;
  • Compound medications of which at least one ingredient is a legend drug not included on the compound exclusion list;
  • Insulin;
  • Needles and syringes;
  • Over-the-counter (OTC) diabetic supplies (except blood glucose testing monitors);
  • Oral and injectable contraceptives;
  • Fertility agents;
  • Legend vitamins;
  • Amphetamines used for ADHD, through age18;
  • Drugs to treat impotency, for males age18 or older (quantity limits apply);
  • Retin-A/Avita (cream only), through age34;
  • Retin-A (gel), with no age restrictions; and
  • Botulinum toxin type A or B (Botox/Myobloc).
Some drugs require prior authorization, such as (this list is not all inclusive):
  • Legend anti-obesity preparations;
  • Amphetamines used for ADHD, age19 or over;
  • Retin-A/Avita (cream only), age35 or over; and
  • Botulinum toxintype A or B (Botox/Myobloc).
HEALTH CARE REFORM
In compliance with the Affordable Care Act, certain prescribed drugs are covered at 100%, not subject to the deductible, if certain conditions are met. Certain dosage and other restrictions apply. If conditions are not met, OTC drugs are not covered and generic drugs are subject to the applicable copay or deductible.
 
Criteria
Aspirin (to prevent cardiovascular disease)
  • Generic OTC
  • Men ages 45 to 79 years and women ages 55 to 79 years old
Aspirin (for preeclampsia)
  • Generic OTC
  • 81 mg
  • Females under age 55
Bowel Preps
  • Generic OTC & Generic Prescription Drugs
  • Men and women ages 50 to 75 years old
Contraceptive Methods for Women
  • Generic barrier methods (diaphragm and cervical cap)
  • Generic hormonal contraceptives
  • Generic emergency contraceptives
  • Prescribed OTC generic contraceptives (except condoms or other men's contraceptives)
Fluoride (oral formulations)
  • Generic OTC & Generic Prescription Drugs
  • Children 6 months of age through 5 years of age
Folic Acid
  • Generic OTC & Generic Prescription Drugs
  • Women through age 50
Smoking Cessation
  • OTC& Prescription Drugs
  • Adults age 18 and over
Vitamin D
  • Generic OTC & Generic Prescription Drugs
  • Adults age 65 and over
Tamoxifen and Raloxifene for breast cancer prevention
  • Generic Prescription Drugs (plus brand Soltamox where medically necessary)
  • Women aged 35 and over for primary prevention only (physician or member must request no copayment)