Drugs Not Covered

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 2024 CVS Caremark 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 coverage for a specific drug, please call CVS Caremark Customer Care at 1 (844) 214-6601.

General exclusions include: 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 through age 17;

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, non-disposable insulin pumps and supplies (covered under medical benefit);

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®);

Deuxis and Vimovo;

Injectable 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.