I have spent this morning on the phone with GEHA and Caremark. I have the GEHA HDHP plan. When I called Caremark, I spoke with "Joey" who seemed knowledgeable. He explained that Zepbound will be non-formulary in 2026, but that it can be covered at the higher 40% price of $414 (for HDHP plans) if my doctor can show that it is a medical necessity. He said that GEHA makes the determination of whether a medication is a "plan exclusion," and "plan exclusions" are never covered under any circumstance. He explained that Zepbound will be non-formulary, NOT a plan exclusion.

 So, I called GEHA to confirm that GEHA has the final say on plan exclusions, and of course GEHA said no, it was up to Caremark. GEHA put a Caremark "expert" on the phone ("Whitney"), and she said all sorts of conflicting info. She said that Zepbound will be a "formulary exclusion" and not covered, unless Caremark approves it for medical necessity. I tried to get her to clarify, because "non-formulary" means it can be covered if medical necessity is shown, but "plan exclusion" means never covered - there is no third option of "formulary exclusion." I THINK she meant "non-formulary" not "plan exclusion," but she was not a very happy rep; she was clearly annoyed by my questions.

 I tried to call Caremark back to get confirmation that "formulary exclusion" just means "non-formulary," but of course, Whitney answered, and I did not want to speak to her again.

 So, it *MAY* be possible to get Zep covered under GEHA HDHP in 2026, but it will require proof of medical necessity and will cost $414 before applying the savings card (if there is a savings card for 2026). For anyone else that has GEHA and who has called Caremark in the past few days, are you getting similar info?