Geisinger Health Plan

The Geisinger Gold $0 Deductible Rx Formulary (drug list) is used for the following Medicare Advantage Plans with Part D Prescription Drug Coverage:

• Geisinger Gold Classic 1 $0 Deductible Rx (HMO)
• Geisinger Gold Classic 3 $0 Deductible Rx (HMO)
• Geisinger Gold Classic 4 $0 Deductible Rx (HMO)
• Geisinger Gold Classic 100 Plus $0 Deductible Rx (HMO POS)
• Geisinger Gold Classic 300 $0 Deductible Rx (HMO)
• Geisinger Gold Preferred 1 $0 Deductible Rx (PPO)
• Geisinger Gold Preferred 2 $0 Deductible Rx (PPO)
• Geisinger Gold Preferred 100 $0 Deductible Rx (PPO)
• Geisinger Gold Preferred 200 $0 Deductible Rx (PPO)
• Geisinger Gold Preferred 3 $0 Deductible Rx (PPO)
• Geisinger Gold Secure 3 $0 Deductible Rx (HMO SNP)
• Geisinger Gold Secure 200 $0 Deductible Rx (HMO SNP)
 
For information about specific prescription drug benefits or to find a network pharmacy, please contact the Pharmacy Customer Service Team at 1-800-988-4861.

> Printable Formulary 

The Geisinger Gold Standard Rx Formulary (drug list) is used for the following benefit packages:

• Geisinger Gold Secure 1 Standard Rx (HMO SNP)

For information about specific prescription drug benefits or to find a network pharmacy, please contact the Pharmacy Customer Service Team at 1-800-988-4861.

> Printable Formulary 

The Geisinger Gold Triple Tier Formulary for Employer Groups benefit assigns each prescription medication to one of three tiers.  Each Tier has a different copayment or coinsurance amount. In general, the higher the cost-sharing tier, the higher your cost for the drug.  Cost-sharing amounts are determined by your Employer. Please contact your employer with questions.

For information about specific prescription drug benefits or to find a network pharmacy, please contact the Pharmacy Customer Service Team at 1-800-988-4861.

> Printable Formulary 

The Geisinger Gold Formulary for Employer Groups benefit assigns each prescription medication to one of two tiers, each representing a cost-sharing amount. The cost-sharing amounts are determined by your Employer. Please contact your employer with questions.

For information about specific prescription drug benefits or to find a network pharmacy, please contact the Pharmacy Customer Service Team at 1-800-988-4861.

> Printable Formulary 

The Triple Choice Formulary benefit assigns each prescription medication to one of three different tiers, each representing a set copayment amount. The copayment amount will depend on your prescription medication rider. Additional medications, other than those included in this formulary, may be covered under the Triple Choice benefit.

For information about specific prescription medication benefits, please contact the Pharmacy Customer Service Team at 1-800-988-4861.

Printable Formularies:

> Geisinger Health Plan / Geisinger Choice Formulary 

> Geisinger Health Options Formulary 

The Traditional Formulary benefit has either a flat copayment/coinsurance, one copayment for generic or one copayment for brand, or assigns each prescription medication to one of two different tiers, each representing a set copayment amount. The copayment amount will depend on your prescription medication rider. Additional medications, other than those included in this formulary, may be covered under the Traditional benefit.

For information about specific prescription medication benefits, please contact the Pharmacy Customer Service Team at 1-800-988-4861.

Printable Formularies:

> Geisinger Health Plan / Geisinger Choice Formulary 

> Geisinger Health Options Formulary 

CHIP is Pennsylvania’s Children’s Health Insurance Program. It provides health insurance to all uninsured children and teens that are not eligible for Medical Assistance.  The CHIP pharmacy benefit assigns each prescription medication to one of two different tiers, each representing a set copayment amount. The copayment amount will depend on which plan you have. Additional medications, other than those included in this formulary, may be covered under the CHIP pharmacy benefit.

For information about specific prescription medication benefits, please contact the Pharmacy Customer Service Team at 1-800-988-4861.

> Printable Formulary 

The West Virginia University Hospitals Employee Formulary assigns each prescription medication to one of three different levels. The tier and resulting copayment are dependent on what the level is and which pharmacy fills the prescription. The copayment amounts and tiers are defined in the plan benefit materials provided by your employer.

For information about specific prescription medication benefits, please contact the Pharmacy Customer Service Team at 1-800-988-4861.

The University Health Associates Employees Formulary assigns each prescription medication to one of three different levels. The tier and resulting copayment are dependent on what the level is and which pharmacy fills the prescription. The copayment amounts and tiers are defined in the plan benefit materials provided by your employer.

For information about specific prescription medication benefits, please contact the Pharmacy Customer Service Team at 1-800-988-4861.

GHP Family is Geisinger Health Plan’s Medical Assistance managed care plan. GHP Family members are assigned to different groups based on their eligibility. Depending on which group you are in, your pharmacy benefit may or may not have a co-payment assigned to your medication. If you do have a co-payment, the amount you will need to pay is based on the tier of the medication. Additional medications, other than those included in this formulary, may be covered under the GHP Family benefit. For information about specific prescription medication benefits, please contact Pharmacy Member Services at 1-855-552-6028.

Members include:

• Children(Ages 0-17)
• Pregnant Women
• Adults(18-20)
• Adults(Over 21)

GHP Family is Geisinger Health Plan’s Medical Assistance managed care plan. GHP Family members are assigned to different groups based on their eligibility. Depending on which group you are in, your pharmacy benefit may or may not have a co-payment assigned to your medication. If you do have a co-payment, the amount you will need to pay is based on the tier of the medication. Additional medications, other than those included in this formulary, may be covered under the GHP Family benefit. For information about specific prescription medication benefits, please contact Pharmacy Member Services at 1-855-552-6028.

Members in this benefit have medical benefits only. They have a pharmacy benefit limited to contraceptives and vaccines ONLY

GHP Family is Geisinger Health Plan’s Medical Assistance managed care plan. GHP Family members are assigned to different groups based on their eligibility. Depending on which group you are in, your pharmacy benefit may or may not have a co-payment assigned to your medication. If you do have a co-payment, the amount you will need to pay is based on the tier of the medication. Additional medications, other than those included in this formulary, may be covered under the GHP Family benefit. For information about specific prescription medication benefits, please contact Pharmacy Member Services at 1-855-552-6028.

Members include:

• Adults(Ages 21-65)