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 (for members covered under the Citi medical and prescription drug plan only; no coverage is provided for a donor who is not covered under the Plan);
  • Certain drugs used for hormone therapy such as testosterone, progesterone, and GnRH agonists (for FTtM) and estrogen, antiandrogens, and GnRH agonist (for MtF);
  • 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;
  • Disposable insulin pumps and continuous blood glucose monitors
  • 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 and generic drugs are subject to the applicable copay or deductible.
 
Criteria
Aspirin (for preeclampsia)
  • Generic OTC with prescription
  • 81 mg
  • Females age 12 to 59
Bowel preps
  • Generic and Single source brands prescription drugs
  • Adults (age 45 to 75)
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
Fluoride (oral formulations)
  • Brand and generic single ingredient prescription drugs
  • Children 5 years of age and younger
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
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)
Preexposure Prophylaxis
  • Generic Truvada (Emtricitabine/tenofovir disoproxil fumarate 200mg-300mg with prescription
  • Preventative use only
  • Quantity limit (1 tab/day)
Statins
  • Generic low-to-moderate-dose statins for members ages 40 to 75