Prescription Plan with the Health Savings Plan (HSP)
With the end of the PHE, the GW medical plan is returning to standard plan coverage and the plan will no longer cover over-the-counter (OTC) COVID-19 home tests. Members may use their savings account plans, such as Health Savings Accounts (HSA) and Flexible Spending Accounts (FSA) to purchase OTC tests. Please note, coverage of FDA approved or authorized physician or health care provider (e.g., pharmacist, nurse, or doctor) ordered lab COVID-19 tests will follow the member’s standard medical plan benefit.
When you enroll in the GW HSP, you are automatically provided with prescription drug coverage through CVS Caremark. You have access to prescription medications through both retail pharmacies and a mail-order program.
- You must pay all out-of-pocket costs for non-preventive prescription drug services up to the annual deductible. This plan does not have copays for prescription services. Once the deductible is satisfied, you will pay your portion of coinsurance until the out-of-pocket maximum is reached. For more information, see page 21 of the 2023 Benefits Guide for Faculty & Staff (PDF).
- Any time you receive a prescription, ask your doctor if a generic option of the drug is available, and whether it’s right for your condition. Doing so can save you hundreds of dollars. After you meet the deductible, you are responsible for 20% coinsurance until you reach the out-of-pocket maximum.
- You may use your Health Savings Account (HSA) to pay for your prescriptions.
- Preventive medications (PDF) are covered at 100% (deductible and coinsurance do not apply).
Please review the list of medications currently considered “Brand, Formulary”, as well as generic equivalents or alternative drugs on the formulary.
- Understanding Prescription Drug Tiers
A drug formulary is a list of medications published by CVS Caremark. Medications on the list fall into one of the following three categories:
1. Generic Drugs: A generic medication is an FDA-approved drug, composed of virtually the same chemical formula as a brand-name drug. Generics are the least expensive category of medications.
2. Brand, Formulary Drugs: If a generic medication is not available for your condition, your doctor may prescribe a brand-name medication. Brand, Formulary Drugs have been evaluated by physicians and pharmacists at CVS Caremark and are deemed the most cost-effective means of treating a specific condition. Brand, Formulary Drugs covered at a slightly higher cost to you than generic drugs, but at a lesser cost than Brand, Non-Formulary Drugs.
3. Brand, Non-Formulary Drugs: In the event that you require a prescription medication that is neither Generic nor on the Brand, Formulary Drug list, you will pay the highest out-of-pocket cost for a Brand, Non-Formulary Drug.
- CVS Caremark Maintenance Choice Program w/Opt Out
If you have a condition that requires ongoing prescription medication, you will receive the lowest total copay possible by requesting that your doctor provide a prescription for a 90-day supply of your medication. You will have the option to fill this 90-day prescription at any CVS retail pharmacy or through CVS Caremark mail order.
If you choose to continue to receive your maintenance prescription in 30-day supply, the number of 30-day fills is limited to three at a retail pharmacy (including CVS). After your third 30-day fill of a maintenance prescription, your medication will not be covered until you take one of two actions:
- Move to a 90-day prescription filled at a CVS retail store OR via CVS Caremark mail order.
- Or, opt out of the program. If you opt out, you can continue filling monthly at your local pharmacy but will forgo the savings and convenience opportunities associated with the program. Deductible/coinsurance applies.
To opt-out of maintenance choice and continue filling a 30-day supply at your local in-network pharmacy, please call 1-877-357-4032.
- Filing a Claim
If you use an out-of-network provider, or if you purchase a prescription and did not have your prescription card with you at the time of purchase, you may need to file a Caremark Prescription Claim (PDF).
- Helpful Resources
- The Primary/Preferred Drug List
- GW HSP Preventive Drugs Covered at 100% (PDF)
- Performance Drug List (PDF)
- Specialty Pharmacy Drug List (PDF)
- Maintenance Choice Prescription Program Overview (PDF)
- Maintenance Choice Prescription Program FAQs (PDF)
- Temporary Prescription Member ID Card (PDF) Note: Requires your CVS Caremark participant ID number.