Citi Benefits Handbook
Drugs Not Covered
For a list of the drugs and products that are not covered under the Citigroup Prescription Drug Program, as well as a list of covered alternatives for select medications, see the 2017 Express Scripts Preferred Drug List Exclusions at Citi Benefits Online. Employees will pay 100% of the full, non-discounted price of these drugs. This list is not exhaustive and there may be other drugs that are not covered. If you have any questions about a specific drug, please call Express Scripts at 1 (800) 227-8338.
General exclusions include:
  • The following medications:
    • Abbott (FreeStyle, Precision)
    • Abstral
    • Acuvail
    • ADV MED TECH
    • (TRUEtest, TRUEtrack)
    • Advocate
    • Alogliptin
    • Alogliptin/Metformin
    • Alvesco
    • Apidra
    • Aranesp
    • Asacol HD
    • Bayer (Breeze, Contour)
    • Beconase AQ
    • Bravelle
    • Cetraxal
    • Cimzia
    • Colchicine
    • Daklinza
    • Delzicol
    • Dipentum
    • Doxycycline 40 MG Capsules
    • Duexis
    • Endometrin
    • Epogen
    • Estrogel
    • Evzio
    • Fentora
    • Fluorouracil 0.5% Cream
    • Follistim AQ
    • Fortesta
    • Ganirelix Acetate
    • Gel-One
    • Genvisc 850
    • Glumetza
    • Hyalgan
    • Hymovis
    • Istalol
    • Kazano
    • Kineret (Exclude for RA)
    • Kombiglyze XR
    • Levitra
    • Mircera
    • Natesto
    • Nesina
    • Novolin
    • NovoLog
    • Nutropin AQ
    • Olysio
    • Omnaris
    • Omnis Health
    • (Embrace, Victory)
    • Omnitrope
    • Onglyza
    • Orencia
    • Pancreaze
    • Pertzye
    • Proventil HFA
    • Qsymia
    • ribasphereribapak
    • RibaTab
    • Roche (Accu-Chek)
    • Saizen
    • Simponi 50 MG
    • Sovaldi
    • Staxyn
    • Stendra
    • Subsys
    • Supartz
    • Supartz FX
    • Synvisc
    • Synvisc-One
    • Taltz
    • Tanzeum
    • Testim
    • Testosterone Gel
    • Ultresa
    • UniStrip
    • Veltin
    • Veramyst
    • Victoza
    • Vimovo
    • Vogelxo
    • Xopenex HFA
    • Zepatier
    • Zetonna
    • Zioptan
    • Zomacton
    • Zyclara
* Sovaldi may be covered for chronic hepatitis C genotypes 2, 3, 5, or 6 with a coverage review.
  • Non-federal legend drugs;
  • Prescription drugs for which there are OTC equivalents available, including, but not limited to, benzoyl peroxide, hydrocortisone, meclizine, ranitidine, and Zantac;
  • Contraceptive implants:
    • Note: Implantable devices such as Mirena or Norplant are covered under the Citigroup Health Benefit Plan (not under the Citigroup Prescription Drug Program portion of the Plan);
  • Drugs to treat impotency for all females and males through age17;
  • Irrigants;
  • Gardasil and Zostavax (vaccinations are covered under the Citigroup Health Benefit Plan; therefore, the provider must bill accordingly);
  • Topical fluoride products;
  • Blood glucose testing monitors (covered under medical benefits);
  • Therapeutic devices and appliances;
  • Drugs whose sole purpose is to promote or stimulate hair growth (e.g., Rogaine®, Propecia®) or are for cosmetic purposes only (e.g., Renova®);
  • Allergy serums;
  • Biologicals, blood or blood plasma products;
  • Drugs labeled "Caution - limited by federal law to investigational use" or experimental drugs, even though a charge is made to the individual;
  • Medication for which the cost is recoverable under any Workers' Compensation or occupational disease law or any state or governmental agency or medication furnished by any other drug or medical service for which no charge is made to the member;
  • Medication that is to be taken by or administered to an individual, in whole or in part, while he or she is a patient in a licensed hospital, rest home, sanitarium, extended-care facility, skilled nursing facility, convalescent hospital, nursing home, or similar institution that operates as, or allows to be operated as, a facility for dispensing pharmaceuticals on its premises;
  • Any prescription refilled in excess of the number of refills specified by the physician or any refill dispensed after one year from the physician's original order; and
  • Charges for the administration or injection of any drug.