Prescription Drug Benefits

Coverage for GW HSP Participants

When you enroll in the GW Retiree HSP, 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. You must pay all out-of-pocket costs for prescription drugs until you meet your annual deductible (combined with medical). After you meet the deductible, you will be responsible for 20 percent in-network coinsurance until you reach the out-of-pocket maximum. You can use your HSA to pay for your prescriptions.

Under the GW Retiree HSP, preventive medications are covered at 100 percent (deductible and coinsurance do not apply). To review a list of preventive drugs, visit hr.gwu.edu/prescription-plan-health-savings-plan-hsp.

PrudentRx for HSP Participants

PrudentRx for specialty medications is included in the GW Retiree 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, which is updated monthly and posted on the Benefits website. Note: Only the amount you pay out of pocket will apply toward your out-of-pocket maximums.

If you opt out, you will be responsible for the 30% coinsurance. 

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

How to Enroll in PrudentRx

After enrolling in the GW Retiree HSP, 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 for HSP Medical Plan

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. Below are the options available to you under the Maintenance Choice Program:

1. Fill your prescription via mail order (90-day supply mailed directly to you)
2. Fill your prescription via retail store that participates in the program (pick up 90-day supply at participating pharmacies)
3. Opt-out* and continue to pick up 30-day supply at in-network pharmacy

If choosing Option 1 or 2, to fill your 90-day prescription:

• Mail Order Service - Learn more about this option by clicking here.
• Select Retail Pharmacies - Login at Caremark.com/pharmacylocator, enter your zip code and filter by "90-day supply" to find a participating pharmacy near you (e.g., CVS, Kroger, Costco).

*To opt-out of maintenance choice and continue filling a 30-day supply at your local in-network pharmacy or for other questions about this program, please call 1-877-357-4032. If you do not opt out, and you continue filling your medications at a retail pharmacy after the initial three 30-day fills, you will be responsible for 100% of the medication's cost.

Next-Generation Transform Diabetes Care Program for the HSP Plan

GW will continue to offer CVS’s Next-Generation Transform Diabetes Care Program for 2026.

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 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.

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.