Check drug costs at info.caremark.com/oe/geha
Elevate Plus 4 You pay
High You pay
Prescription benefits in-network 1,2,3
$10
$10 5
30-day retail generic
25% ( $150 max 5,6 ) 40% ( $200 max 5,6 )
$80 6
30-day retail preferred brand-name
50% 6
30-day retail non-preferred brand-name
$20
$20
90-day mail service generic
25% ( $350 max 6 ) 40% ( $500 max 6 ) 25% ( $150 max 6 ) 40% ( $200 max 6 )
$200 6
90-day mail service preferred brand-name
50% 6
90-day mail service non-preferred brand-name
40% ( $500 max 6 )
30-day specialty CVS exclusive generic and preferred brand-name
30-day specialty CVS exclusive non-preferred brand-name
50% 6
1 In-network providers agree to limit what they will charge you. You pay a fixed dollar amount or a percentage of the provider’s negotiated amount. 2 The out-of-pocket maximum is the maximum amount of coinsurance and copays you pay for all family members before GEHA begins paying for 100% of covered services. This is a combined maximum for both medical care and prescriptions. 3 Refer to geha.com/Prescriptions for formulary and specialty coverage for specific medications. 4 This plan has no out-of-network coverage 5 Costs for initial prescription and first refill. You pay 50% for third and additional refills at retail for 30-day supply. For long-term prescriptions, use mail order or your local retail CVS Pharmacy store (90-day supply) for greater cost savings. 6 If you choose a brand-name medication when a generic is available, you will be charged the generic copay plus the difference in cost between the brand-name and the generic.
Save more with mail order prescriptions With CVS Caremark’s Mail Service Pharmacy, you can save money and have your routine prescriptions delivered to your home, postage-paid, within about 14 days from the time you submit your prescription. Mail order is not available for the Elevate plan option.
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2023 GEHA medical plans
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