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 2018 Express Scripts Preferred Drug List Exclusions at Citi Benefits Online. You 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)
    • Abilify*
    • Abstral
    • Aciphex*
    • Aciphex Sprinkle
    • Acuvail
    • Adderall*
    • Adlyxin
    • Aktipak
    • Alogliptin
    • Alogliptin/Metformin
    • Alvesco
    • Androgel 1%*
    • Anusol-HC*
    • Apidra
    • Aranesp
    • Asacol HD
    • Atacand*
    • Atacand HCT*
    • Auvi-Q
    • Azor*
    • Bayer (Breeze, Contour)
    • Beconase AQ
    • Benicar*
    • Benicar HCT*
    • Bravelle
    • Bupap*
    • Buprenorphine Patches
    • Butrans
    • Cetraxal
    • Colchicine
    • Cymbalta*
    • Cytomel*
    • Daklinza
    • Delzicol
    • Dipentum
    • Doxycycline 40 MG Capsules
    • Effexor XR*
    • Emflaza
    • Endometrin
    • Epinephrine Auto-Injector (by A-S Medications, Impax & Lineage)
    • Epogen
    • Estrogel
    • Evzio
    • Exondys 51
    • Femring
    • Fentora
    • Fluorouracil 0.5% Cream
    • Follistim AQ
    • Forteo
    • Fortesta
    • Fosrenol
    • Ganirelix Acetate
    • Gel-One
    • Gelsyn-3
    • Genvisc 850
    • Glumetza*
    • Hyalgan
    • Hymovis
    • Imitrex*
    • Inderal LA*
    • Intuniv*
    • Istalol
    • Kazano
    • Kombiglyze XR
    • Lazanda
    • Levalbuterol HFA
    • Levitra
    • Lexapro*
    • Librax*
    • Lidoderm*
    • Lovenox*
    • Lunesta*
    • Mesalamine 800 MG Delayed-Release
    • Minastrin 24 Fe*
    • Mircera
    • Nasonex*
    • Natesto
    • National Medical (Advocate)
    • Nesina
    • Neupogen
    • Nevanac
    • Novolin
    • NovoLog
    • Nutropin AQ
    • Nutropin AQ Nuspin
    • Olysio
    • Omnaris
    • Omnis Health
    • (Embrace, Victory)
    • Omnitrope
    • Onglyza
    • Opana ER
    • Oxycodone ER
    • Pancreaze
    • Pertzye
    • Plaquenil*
    • Plavix*
    • Prevacid*
    • Prevacid Solutab
    • Prilosec Suspension
    • Pristiq*
    • Protonix*
    • Protonix Suspension
    • Proventil HFA
    • Provigil*
    • Prozac*
    • Pulmicort Respules*
    • Qsymia
    • Renagel
    • Roche (Accu-Chek)
    • Saizen
    • Saizen Prep
    • Sandostatin LAR Depot
    • Seroquel*
    • Seroquel XR*
    • Signifor LAR
    • Singulair*
    • Sovaldi
    • Staxyn
    • Stendra
    • Strattera*
    • Sumavel Dosepro
    • Supartz
    • Supartz FX
    • Synvisc
    • Synvisc-One
    • Tanzeum
    • Testim
    • Testosterone Gel
    • Tikosyn*
    • Timoptic Ocudose
    • Tobi Solution*
    • Tribenzor*
    • Trividia (TRUEtest, TRUEtrack)
    • Trulance
    • Ultresa
    • UniStrip
    • Valium*
    • Valtrex*
    • Veltin
    • Victoza
    • Vogelxo
    • Vytorin*
    • Wellbutrin SR*
    • Xanax*
    • Xanax XR*
    • Xenazine*
    • Xopenex HFA
    • Zegerid*
    • Zepatier
    • Zetia*
    • Zetonna
    • Zioptan
    • Zoloft*
    • Zomacton
    • Zyclara
    • Zyflo CR*
* .Multisource brand exclusion – The generic equivalent of this brand-name medication is covered under the Plan. FDA-approved generic medications meet strict standards and contain the same active ingredients and their corresponding brand-name medications, although they may have a different appearance.
  • 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 Benefits Plan (not under the Citigroup Prescription Drug Program portion of the Plan);
  • Drugs to treat impotency for all females and males through age 17age17;
  • Irrigants;
  • Gardasil and Zostavax (vaccinations are covered under the Citigroup Health Benefits 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.