Retiree Health Summary Plan Description
As of February 1, 2018
En Español (PDF)

5.7 Limitations

The following items are a covered benefit subject to the limitations as stated below:

  1. Drugs prescribed to treat erectile dysfunction (including, but not limited to, Viagra™, Cialis™ and Levitra™) are covered for a maximum of eight (8) pills for a 30-day supply.
  2. Smoking deterrents, when prescribed in writing by a physician, subject to the following limitations:
    1. Up to a 90-day supply per year; and
    2. No more than a 180-day supply per lifetime.
    This limitation applies to smoking deterrents received from both a retail pharmacy and the Citizens Rx Home Delivery service. It is recommended you discuss a treatment Plan with your physician. There are many products to assist you in smoking cessation, including:
    1. Nicotine patches;
    2. Nicotine gum;
    3. Nicotine nasal spray (prescription required);
    4. Nicotine inhalers (prescription required);
    5. Nicotine lozenges; and
    6. Zyban™ (Bupropion) (prescription required).
  3. Morning After pills and kits (i.e. Preven™, Plan B™) – limited to two (2) total per person per 365 days.