How the Prescription Drug Plan Works
The CVS Caremark Brand and Generic Preventive Drug List is a list of drugs covered at 100% with no copays, as determined by CVS Caremark. To see a list of drugs in this category, visit CVS Caremark's website, which is accessible via My Health. Please note, only drugs on CVS Caremark's formulary are covered. Inclusion of a drug on the Preventive Drug List does not guarantee coverage. Step therapy, prior authorization, or quantity limits may apply. Mandatory Generic Drug Program applies.
Highlights of prescription drug coverage are listed below; detailed information follows.
- There is no deductible for prescription drug coverage;
- Free preventive drugs. Covered preventive medications are covered at 100% ($0 cost) at network pharmacies. Please Note: Generic prescription contraceptives are also fully covered (as are brand-name, contraceptive drugs for which a generic is not available);
- Your copay for prescription drugs count toward the prescription drug out-of-pocket maximum that is separate from the medical out-of-pocket maximum;
- MRA funds can be used to pay for covered out-of-pocket prescription drug costs;
- If you have elected automatic claim payment, at the time of purchase, your MRA funds will automatically be used to offset your out-of-pocket cost after the Plan pays its share of the cost of your medication. If you elected or were automatically assigned the debit card, you may pay your out-of-pocket costs by using the card or your own funds. If you pay out-of-pocket, you can submit a claim form for reimbursement from the MRA. Once your MRA funds are depleted, you can use your HCSA for eligible prescription drug expenses if you elected to participate in the HCSA and have available funds.
- If you elected autopay during enrollment, you are allowed to make a one-time mid-year switch to the debit card option that will be effective the first of the following month by calling 1-844-ASK-JPMC.
- Discounted prices are available at network pharmacies (you'll generally pay more at an out-of-network pharmacy); if you use an out-of-network pharmacy that does not accept your prescription drug ID card, you will generally pay more and will need to file a claim for eligible reimbursement;
- Plan Option of having maintenance prescriptions filled through a convenient mail-order program or at a pharmacy; Maintenance Choice® offers advantageous pricing when you receive 90-day supplies of maintenance medication by mail or pick up your prescription at a participating pharmacy (including CVS retail pharmacies), where the same discounts are available;
- Traditional (non-specialty) and specialty lists of preferred/covered and excluded drugs; the most recent lists can always be found on the CVS Caremark website;
- Mandatory Generic Drug Program; if you fill a prescription for a brand-name medication when a generic equivalent is available, you will pay the difference in cost between the brand-name drug and generic drug, plus the generic copay.