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Highlights of the 2023 JPMorgan Chase U.S. Benefits Program
For employees living in all states except Arizona and Ohio
Prescription Drug Benefit Provisions
1
Coverage for Option 1 and Option 2
Retail (up to a 30-day supply)
Preventive drugs Covered 100% for eligible brand and generic drugs.
Mandatory Generic Program applies.
Generic drugs • Non-specialty: You pay $10 with no deductible
• Specialty: You pay 30% after deductible, up to
$200 max
Preferred brand-name drugs Non-specialty/specialty: You pay 30% after deductible,
up to $200 max
Non-preferred brand-name drugs Non-specialty/specialty: You pay 45% after
deductible, up to $250 max
Annual deductible
(employee
2
/employee + spouse/domestic partner or
children/employee + spouse/domestic partner +
children)
$100/$200/$300
Mail Order (up to a 90-day supply)
Preventive drugs Covered 100% for eligible brand and generic drugs.
Mandatory Generic Program applies.
Generic drugs • Non-specialty: You pay $20 with no deductible
• Specialty: You pay 30% after deductible, up to
$500 max
Preferred brand-name drugs Non-specialty/specialty: You pay 30% after
deductible, up to $500 max
Non-preferred brand-name drugs Non-specialty/specialty: You pay 45% after
deductible, up to $625 max
Annual deductible N/A
Annual Prescription Out-of-Pocket Maximum
(employee
2
/employee + spouse/domestic partner or
children/employee + spouse/domestic partner +
children)
$1,150/$1,750/$2,300; includes copays and
coinsurance for covered drugs; does not include
annual retail deductible or costs for non-covered
drugs
1
The prescription drug copay and coinsurance amounts are maximums; if the cost of the drug is less than the copay/coinsurance,
then you pay the cost of the drug.
2
For both the annual deductible and out-of-pocket maximum, the “per person” rule applies. Please see page 13 for additional
information.
Mandatory Generic Program
The plan contains a mandatory generic drug program in which generic drugs are substituted
for certain brand-name prescription drugs. If you fill your prescription with a brand-name
drug when a direct generic equivalent is available, you will pay the entire cost difference
between the brand-name and generic drug plus the non-specialty generic drug copay. Please
note: These cost differences will not be limited by per-prescription maximums or annual
out-of-pocket maximum limits. Your physician can contact CVS Caremark to seek a medical
exception review for possible approval for specific clinical reasons.
Fill Long-Term Prescription Drugs through Mail Order
One of the features of Option 1 and 2 is the discount available for long-term maintenance
prescriptions purchased in bulk by CVS Caremark and fulfilled through the mail-order
prescription service. This program, known as the CVS Caremark Maintenance Choice® Program,
saves both you and JPMorgan Chase money.
If you are taking a long-term medication, this program allows you the flexibility to receive your
90-day supply by mail through CVS Caremark’s mail-order prescription service or by picking
up your 90-day supply at a CVS retail pharmacy. If you prefer not to participate in the
CVS Caremark Maintenance Choice Program, you may opt out and obtain a 90-day supply
(or a 30-day supply) at any participating network pharmacy, but you may have to pay more.
Please keep in mind that it may be more cost-effective for you to use the CVS Caremark
Maintenance Choice Program.
Important Notes
• Your Prescription Drug Plan uses
CVS Caremark’s standard drug lists
(Specialty and Non-Specialty) of covered
and excluded (not covered) drugs. These
lists are subject to change quarterly by
CVS Caremark. An independent
committee made up of pharmacists,
physicians and medical ethicists reviews
and approves these drug lists (also
known as a Formulary). To access these
drug lists, visit the CVS Caremark
website at https://www.caremark.com
or via My Health.
•
If you choose to take a non-covered drug,
you will pay the full cost of the drug. This
could be a costly option. Be sure to
carefully consider how the costs of taking
a non-covered drug could add up.
•
Your prescription drug plan may have
special programs associated with specific
drug therapies. Some medications may
require prior authorization, have quantity
limits associated with them or be
excluded from coverage.
DON’T FORGET: You can use your Medical
Reimbursement Account (MRA) to help
pay for prescription drug deductibles,
copayments and coinsurance.
Free Preventive Drugs
To encourage preventive care, eligible
preventive brand and generic drugs on
CVS Caremark’s standard preventive drug
list are covered at 100% with no copays.
Preventive drugs are medications that can
help prevent the onset of a condition if
you are at risk or help you manage your
health if you have a condition. If you enroll
in Option 1 or 2, see the Preventive Drug
List for a list of drugs covered at 100%, as
determined by CVS Caremark. The list can
be found on CVS Caremark’s website, on
the Covered Drug List (Formulary) section
of the Plan & Benefits tab, through My
Health. Please note: Some strengths or
dosage forms may not be included in the
Brand and Generic Preventive Therapy
Drug list, and certain drugs, products or
categories may not be covered regardless
of their appearance on this list. Certain
drugs are subject to step therapy, prior
authorization or quantity limits. For the
latest coverage information, please
contact CVS Caremark.
The Mandatory Generic Drug Program
applies.If you fill a prescription for a
brand-name drug when a direct generic
equivalent is available (e.g., if you fill
Lipitor instead of atorvastatin), you will
pay the entire cost difference.