CVS Caremark Prescription Drug Reimbursement Form

GEHA health plan members and GEHA secondary members (including members who have Medicare Part D or other primary coverage) should use this form to submit prescription receipts when a participating pharmacy is not available. GEHA secondary members must submit claims to their primary carrier before filing for reimbursement from GEHA. Please include your primary carrier's explanation of benefits (EOB) with this form. Complete instructions are included on the form.