Prescription Drug Benefits

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

The GW Retiree HSP covers preventive medications at 100 percent (deductible and coinsurance do not apply). To review a list of preventive drugs, visit hr.gwu.edu/benefits.

For non-preventive medications, 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.

To Opt Out of the Maintenance Choice Program

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.

Maintenance Choice Prescription Program for HSP and PPO Medical Plans

If you have a condition that requires ongoing prescription medication, you will receive the lowest total co-pay 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.

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.

Check Drug Coverage Tiers

It’s a good idea to occasionally check up on your medications’ coverage tier (generic, brand formulary and brand non-formulary), as drugs can sometimes change tiers. To be certain which tier your medication is in, call CVS Caremark at (877) 357-4032, visit caremark.com or download the CVS Caremark Mobile App.

Next-Generation Transform Diabetes Care Program for the HSP and PPO Plans

GW will continue to offer CVS’s Next-Generation Transform Diabetes Care Program for 2024.

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.