Prescription Plan with the PPO Medical Plan
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 PPO, 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.
Under the prescription plan, generic, brand formulary and brand non-formulary drugs will be paid by fixed percentage of the total cost each time you fill a prescription. For more information, see page 20 of the Benefits Guide for Faculty & Staff (PDF).
Real World Tips:
- 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.
- 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.
- The number of 30-day fills for maintenance prescriptions at a retail pharmacy (including CVS) is limited to three. After your third 30-day fill of a maintenance prescription, you will pay the higher cost. To pay the lowest cost possible, be sure to obtain a 90-day prescription from your doctor and fill via mail order or at a CVS/pharmacy.
A drug formulary is a list of medications published by CVS Caremark. Medications on the list fall into one of the following three categories:
- 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.
- 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 to be 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.
- 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.
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.