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 age 18;
  • Drugs to treat impotency, for males (quantity limits apply);
  • Retin-A/Avita (cream only), through age 34; and
  • Retin-A (gel), through age 34.
Some drugs require prior authorization, such as (this list is not all-inclusive):
  • Legend anti-obesity preparations;
  • Amphetamines used for ADHD, age 19 or over;
  • Retin-A/Avita (cream only), age 35 or over; and
  • Botulinum toxin type A or B (Botox/Myobloc).
Health Care Reform
In compliance with the Affordable Care Act, certain prescribed drugs, as indicated below, 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 with prescription
  • Adults (age 50 – 59)
Aspirin (for preeclampsia)
  • Generic OTC with prescription
  • 81 mg
  • Females age 12 to 59
Bowel preps
  • Generic and Single source brands prescription drugs
  • Men and women ages 50 to 74
Contraceptive methods for women
  • Generic and single source brands barrier methods (diaphragm and cervical cap)
  • Generic and single source brands hormonal contraceptives
  • Generic and single source brands emergency contraceptives
  • Prescribed OTC generic contraceptives (except condoms or other men's contraceptives)
Fluoride (oral formulations)
  • Brand and generic prescription drugs
  • Children 6 months of age through 5 years of age
Folic acid
  • Generic OTC (with prescription) and generic prescription drugs
  • Women through age 55
Smoking cessation
  • OTC (with prescription) and prescription drugs
  • Adults age 18 and over
Vitamin D
  • Generic OTC (with prescription) and generic prescription drugs
  • Adults age 65 and over
Tamoxifen and Raloxifene for breast cancer prevention
  • Generic prescription drugs
  • Women ages 35 and over for primary prevention only (physician or member must request no copay)
Statins
  • Generic low-to-moderate-dose statins for members ages 40 to 75