The 2025 Open Enrollment that began October 7, 2024 and ended on October 25, 2024 at 8pm (ET) is now closed.
Prescription Drug Benefits
Coverage for GW LTD PPO Participants
When you enroll in the GW LTD PPO, you are automatically enrolled in 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 are paid by fixed percentage of the total cost each time you fill a prescription, with caps in place to limit the amount you will spend on a prescription (referred to as a maximum).
PrudentRx for LTD PPO Participants
PrudentRx for specialty medications is included in the GW LTD 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, which is updated monthly and posted on the Benefits website.
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).
How to Enroll in PrudentRx
After enrolling in the GWU LTD PPO plan, you will be contacted via phone to enroll in PrudentRx at the time of your first specialty fill. You must complete any additional enrollment steps with PrudentRx to receive the $0 benefit.
Important: Members must enroll in the PrudentRx program to access $0 copay benefits. Formulary exclusions will supersede this list.
If a participant’s specialty medication is not on the PrudentRx list, then the brand formulary or brand non-formulary plan design will apply.
For additional information, visit hr.gwu.edu/prudent.
Maintenance Choice Prescription Program with All Access 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. 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, 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.
Note: Maintenance Choice provisions apply. After three 30-day retail fills, you will need to fill a 90-day prescription via CVS Retail or CVS Mail Order or contact customer service to opt-out and continue filling at your local pharmacy, in order to continue receiving the preventive medication at no cost.
Next-Generation Transform Diabetes Care Program
Managing diabetes can be difficult and costly for patients. On average, people with diagnosed diabetes incur medical expenses that are approximately 2.3 times higher than those of non-diabetics, according to the American Diabetes Association. Studies have shown that overall health can be improved (and medical costs can be significantly reduced) through better lifestyle management, medication adherence and control of A1C.
GW will continue to offer CVS’s Next-Generation Transform Diabetes Care Program for 2025.
Many condition management programs take a one-size-fits-all approach based on principles of population health. This program focuses on a highly personalized approach, customizing support based 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 and from Certified Diabetes Educators
- Two comprehensive diabetes visits at MinuteClinic locations at no out-of-pocket cost, including A1C checks
- Access to digital tools within the CVS Pharmacy mobile app, including medication refill reminders as well as the ability to refill prescriptions via two-way text messaging
Note: Diabetic medications and supplies must be filled through CVS Retail or CVS Mail Order.
Tip: Check Drug Coverage Tiers
It’s a good idea to occasionally check up on your medications’ coverage tier (generic, brand formulary, brand non-formulary), as drugs can sometimes change tiers. To check a medication's coverage tier, call CVS Caremark at (877) 357-4032, visit caremark.com or download the CVS Caremark Mobile App.