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Geisinger Gold (Medicare Part D)

Geisinger Gold $0 Deductible Rx Plans

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

2023 searchable formularies:

For information about specific prescription medication benefits, contact the pharmacy customer care team at 800-988-4861.

Click here to view the printable 2023 Pharmacy Directory

Click here to view the printable 2023 Geisinger Gold $0 Deductible Rx Formulary (updated August 29, 2023/effective September 1, 2023)

Important Message About What You Pay for Vaccines – Our plan covers most Part D vaccines at no cost to you. Call Member Services for more information.

Important Message About What You Pay for Insulin – You won’t pay more than $35 for a one-month supply of each insulin product covered by our plan, no matter what cost-sharing tier it’s on.


Geisinger Gold Standard Rx Plans

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

For information about specific prescription medication benefits, contact the pharmacy customer care team at 800-988-4861.

Click here to view the printable 2023 Geisinger Gold Standard Rx Formulary (updated August 29, 2023/effective September 1, 2023)

Important Message About What You Pay for Vaccines – Our plan covers most Part D vaccines at no cost to you. Call Member Services for more information.

Important Message About What You Pay for Insulin - You won't pay more than $0 for a one-month supply of each insulin product covered by our plan, even if you haven't paid your deductible.


Geisinger Gold Triple Tier for Employer Groups Plans

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. Contact your employer with questions. 

Click here to view the printable 2023 Geisinger Gold Rx Triple Tier for Employer Groups Formulary (updated August 23, 2022/effective January 1, 2023)

Important Message About What You Pay for Vaccines – Our plan covers most Part D vaccines at no cost to you. Call Member Services for more information.

Important Message About What You Pay for Insulin – You won’t pay more than $35 for a one-month supply of each insulin product covered by our plan, no matter what cost-sharing tier it’s on.


All other plans

Geisinger Triple Choice 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, contact the pharmacy customer care team at 800-988-4861.


Geisinger Traditional 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, contact the pharmacy customer service team at 800-988-4861.


Geisinger High Performance Rx Formulary

The High Performance Rx 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 High Performance Rx benefit.

For information about specific prescription medication benefits, contact the pharmacy customer care team at 800-988-4861.


Geisinger 4th Tier

The 4th Tier Formulary benefit assigns each prescription medication to one of four 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 4th Tier benefit. 
 
For information about specific prescription medication benefits, contact the pharmacy customer care team at 800-988-4861.

Geisinger Marketplace Plans

With Geisinger Marketplace Plans, each prescription medication is assigned to one of six tiers, each with a set copayment or coinsurance amount. The copayment/coinsurance amount will depend on your prescription medication rider. Additional medications, other than those included in this formulary, may be covered by Geisinger Marketplace Plans.

2023 Searchable Formulary for Geisinger Marketplace Plans

Click here to view the printable 2023 Geisinger Marketplace (effective September 1, 2023)

For information about specific prescription drug benefits or to find a network pharmacy, contact the pharmacy customer care team at 800-988-4861.


CHIP 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, contact the pharmacy customer care team at 800-988-4861.

All pharmacy providers in Pennsylvania (PA) must be enrolled with the PA Department of Human Services (DHS) and have a valid Pennsylvania Medicaid ID# to dispense medications for GHP Kids members. Please check with the pharmacy to ensure they have a current Medicaid ID before presenting prescription. 


Northern Light Employee Plan

Northern Light Employee Plan 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, contact the pharmacy customer care team at 800-988-4861


AON Health Exchange

The AON Active Health Exchange 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, contact the pharmacy customer care team at 800-988-4861.


Geisinger Employee Plan

Geisinger Employee Plan 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, contact the pharmacy customer care team at 800-988-4861

GHP Family

Medical Assistance

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. Pharmacy copays will apply to members 18 years of age and older unless otherwise listed below. Brand name prescription drugs have a $3 copayment. Generic prescription and over-the-counter drugs have a $1 copayment. Services cannot be denied if the member is unable to afford the copay. There are no copays for: 

  • Pregnant women (including the postpartum period which ends 60 days after delivery)
  • Children under 18 years of age
  • Medical benefit drugs
  • Members in a nursing home
  • Members receiving hospice care
  • Members in an Intermediate Care Facility for Mental Retardation or Intermediate Care Facility for Other Related Conditions 
  • Family planning drugs or supplies 
  • Drugs, including immunizations, when dispensed and/or administered by a physician 
  • Title IV-B Foster Care and IV-E Foster Care and Adoption Assistance
  • Members eligible under the Breast and Cervical Cancer Prevention and Treatment Programs 

There is no copay for the following groups of medications:

  • Antihypertensives (high blood pressure) 
  • Antidiabetes (high blood sugar) 
  • Anticonvulsants (seizure) 
  • Cardiovascular preparations (heart disease)
  • Antipsychotics (except those that are controlled substance antianxiety drugs) 
  • Antineoplastics (cancer drugs) 
  • Antiglaucoma drugs 
  • Anti-Parkinson’s drugs
  • HIV/AIDS drugs 
  • Preferred naloxone injection/nasal spray for drug overdose.

For information about specific prescription medication benefits, contact pharmacy member services at 855-552-6028.

All pharmacy providers in Pennsylvania (PA) must be enrolled with the PA Department of Human Services (DHS) and have a valid Pennsylvania Medicaid ID# to dispense medications for GHP Family members. Please check with the pharmacy to ensure they have a current Medicaid ID before presenting prescription.

Geisinger Health Plan, like other Medicaid Managed Care Organizations, follows the Statewide Preferred Drug List (PDL). The Statewide PDL is a list of preferred drugs developed by the Department of Human Services’ (DHS) Pharmacy and Therapeutics Committee. Medications not on the PDL follow the GHP Family Formulary. Click to view the Statewide Preferred Drug List (PDL).

 

Need help? Call 800-988-4861 or 570-271-5673, Monday through Friday, 8 a.m. — 5 p.m.

View formulary updates and current drug recalls here.
Y0032_23111_1_M Accepted 4/26/23
For the fourth year in a row, Geisinger Health Plan is ranked #1 by J.D. Power for its excellence in customer service for commercial group.

Because we put you first

For the fourth year in a row, Geisinger Health Plan is ranked #1 in Member Satisfaction among Commercial Health Plans in Pennsylvania by J.D. Power.