Prescription Plan

When you enroll in one of the medical plan options, you are automatically provided with prescription drug coverage through CVS Caremark. You have access to prescription medications through both retail pharmacies and mail-order program. The CVS mobile app and digital tools make sit easy to manage your prescriptions on your own time.

Prescription coverage for the GW Health Savings Plan and GW PPO Plan have differences, so be sure to consider your prescription drug needs with medical needs.

Benefits Tip: You will receive two separate ID cards for medical (UHC) and prescription (CVS Caremark) if you elect one of GW’s medical plans.

Prescription Plan Features/Programs

Diabetes Management Program

Many condition management programs take a one-size-fits-all approach based on principles of population health. CVS’s Next Generation Transform Diabetes Care focuses on a highly personalized approach, customizing support based on a participant's risk profile.

This program is designed to improve health outcomes and lower pharmacy costs through three key components: medication adherence, A1C control and lifestyle management. Program features include:

• Highly personalized support from Certified Diabetes Care Nurses.
• Two comprehensive diabetes visits at MinuteClinic locations, or virtually, at no out- of-pocket cost, including A1C checks. These can be downloaded from the CVS app.
• A meter that best suits your condition. Test strips and lancets will be available at $0 out-of-pocket cost.
• Access to digital tools within the health optimizer or CVS Pharmacy mobile app, including medication refill reminders, nutritional assessments, as well as the ability to refill prescriptions via two-way text messaging with your diabetes care nurse.

NOTE: Diabetic medications and supplies must be filled through CVS Retail or CVS Mail Order.

PrudentRx available via the GW PPO and HSP Pharmacy Benefit

PrudentRx for specialty medications is available via the GW PPO Pharmacy Benefit. This program is designed to lower your out-of-pocket costs by assisting you with enrollment in drug manufacturers discount copay cards/assistance programs. When enrolled in PrudentRx, your out-of-pocket cost will be $0 for medications included on the PrudentRx exclusive specialty drug list.

If you opt out, you will be responsible for the 30% coinsurance (only the amount you pay out of pocket will apply toward your deductible/out of pocket maximums for essential health benefit medications.

IMPORTANT: Members must enroll in the PrudentRx program to access $0 copay benefits.

PrudentRx for specialty medications is available via the GW HSP Pharmacy Benefit. This program is designed to lower your out-of-pocket costs by assisting you with enrollment in drug manufacturers discount copay cards/assistance programs. When enrolled in PrudentRx, your out-of-pocket cost will be $0 for medications included on the PrudentRx exclusive specialty drug list.

If you opt out, you will be responsible for the 30% coinsurance (only the amount you pay out of pocket will apply toward your deductible/out of pocket maximums for essential health benefit medications.

*HSP participants must meet their combined medical/prescription deductible before the out of pocket cost will be $0.

IMPORTANT: Members must enroll in the PrudentRx program to access $0 copay benefits.

Mandatory Maintenance Choice – All Access with Opt-Out

Under the Maintenance Choice program, the number of 30- day fills for maintenance prescriptions at a retail pharmacy (including CVS) is limited to three. After their third 30-day fill members will be prompted to either move their prescription to CVS or contact customer care to opt out and continue filling at their local pharmacy. Through this program, participants gain access to delivery offerings:

• On-Demand Delivery – Four-hour delivery offered within 10 miles of any CVS Pharmacy store, for a small fee.
• One- to Two-Day Delivery – Delivery provided by USPS within 1-2 days, at no extra cost to the member.