Geisinger Gold Rx plans

We offer an option that includes coverage for prescription drugs only – our Geisinger Gold Rx plan. They are available in every county in Pennsylvania, as well as in West Virginia.

These are our stand-alone prescription drug plans. So, if you have Original Medicare or a Medicare Supplement plan, you can enroll. You also may add them to the Geisinger Gold Open 1, Open 2 and Reserve plans.

Geisinger Gold Rx plans offer you:

A way to help you save money on prescriptions you may take now and in the future
Coverage for thousands of drugs that are part of our formulary
Ability to have your prescriptions filled at pharmacies and pay a co-pay for medications
Prescription mail order service — that can save you even more money
Benefits that are equal to or better than Medicare's requirements

Geisinger Gold Rx Plans available You have a very simple choice between our plans in Pennsylvania and West Virginia. Choose Between the Geisinger Gold Rx 1 or the Geisinger Gold Rx 2. Compare the coverage available:
	Gold Rx 1	Gold Rx 2
	Member pays	Member pays
Plan Premium	$31.20 per month	$28.60 per month
Deductible	$275 per year	$175 per year
Initial Coverage Level Up to $2,510 (after member pays annual deductible)	25% of drug costs	Retail Pharmacy (for one-month supply/copay for one month) $3 copay (Tier One Drugs) $40 copay (Tier Two Drugs) $90 copay (Tier Three Drugs) Mail Order Pharmacy (for three-month supply/copay for three months) $9 copay (Tier One Drugs) $120 copay (Tier Two Drugs) $282 copay (Tier Three Drugs) Long-Term Care Pharmacy (for one-month supply/copay for one month) $X copay (Tier One Drugs) $XX copay (Tier Two Drugs) $XX copay (Tier Three Drugs
Coverage Gap After yearly drug costs reach $2,510 and until yearly out-of-pocket drug costs reach $4,050	100% of costs	100% of costs
Catastrophic Coverage	Whichever is greater: $2.25 copay for generic drugs (including brand drugs treated as generics) $5.60 copay for all other drugs 5% coinsurance	Whichever is greater: $2.25 copay for generic drugs (including brand drugs treated as generics) $5.60 copay for all other drugs 5% coinsurance

Covered medications

The Geisinger Gold Rx plans cover a wide range of medications. They are part of our formulary, the drugs our plans cover.

The drugs on our formulary were selected by Geisinger Gold in consultation with a team of healthcare providers. They represent the prescription therapies believed to be a necessary part of a quality treatment program.

The two formularies have three tiers:

Tier 1 – Generic
Tier 2 – Preferred Brand
Tier 3 – Non-Preferred Brand

Find out which drugs are covered

For stand-alone prescription drug plans (Geisinger Gold Rx 1 and Geisinger Gold Rx 2), take a look at the two formularies.

You may also print out a formulary: Rx 1 Rx 2

We will send you a formulary, if you request a copy.

Medicare prescription drug plan eligibility requirements

To enroll in a Medicare prescription drug plan, you have to meet eligibility requirements
If you're entitled to Part A and/or enrolled in Part B of Original Medicare & live in the service area, you're eligible to join

Note: You must continue paying your Medicare Part B premiums. Also, if you purchase a stand-alone Medicare drug plan while you're enrolled in a Medicare Advantage plan with prescription drug coverage (MAPD), you'll be automatically disenrolled from the MAPD plan.

Find out more about Geisinger Gold Rx plans:

Premiums and details of coverage Enrollment in Geisinger Gold Rx plans Eligibility Formulary (List of Covered Drugs) Grievance and Appeals - Coming Soon Frequently Asked Questions about Prescription Drug Coverage Click here for additional important information about the Health Plan's policies and procedures.

Call for answers and information

1-800-631-1656
1-800-447-2833 (TTY/TDD)
8 a.m. to 8 p.m., seven days a week

Find a Geisinger Gold Meeting in your area and attend.

Fill out an online request form for information.

Geisinger Gold Rx is a Medicare Prescription Drug Plan that contracts with Medicare. Beneficiaries can join this plan if they are entitled to Medicare Part A and/or enrolled in Medicare Part B and live in the service area.

Eligible individuals may only enroll in one Medicare Prescription Drug Plan at a time and may not be enrolled in a Medicare Advantage Plan (HMO, PPO, PFFS), unless they are a member of a Medicare Private-Fee-for-Service Plan or are enrolled in an 1876 Cost Plan.

Summary of Benefits

Evidence of Coverage - Coming Soon

H3924_H3954_H5812_S4248_7262_1_a_r 10/14/07
H8468_7262_1_a_r vb 10/9/07

Extra Financial Help

You may qualify for extra help from Medicare to assist with paying for your Prescription Drug Coverage. See additional information.

You may also qualify for help through PACE or PACENET programs.