What you pay for drugs

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Find the cost for your drug

What you pay for prescription drugs under UMP Classic

How much you pay depends on the tier your prescription drug is in. The prescription drug deductible applies to Tier 2 and Tier 3 drugs as indicated in the table below.

You can get up to a 90-day supply for most drugs—except for specialty drugs, which are usually limited to a maximum 30-day supply.

Tier All network pharmacies
Retail and mail-order
The most you'll pay
(prescription cost-limit)
Network pharmacies only
Value Tier 5% coinsurance
No deductible
$10—Up to a 30-day supply
$20—31-60 days’ supply
$30—61-90 days’ supply
Tier 1
Select generic drugs
10% coinsurance
No deductible
$25—Up to a 30-day supply
$50—31-60 days’ supply
$75—61-90 days’ supply
Tier 2
Preferred drugs
30% coinsurance
Deductible applies
$75—Up to a 30-day supply
$150—31-60 days’ supply
$225—61-90 days’ supply
Tier 3
Nonpreferred drugs
50% coinsurance
Deductible applies
Specialty drugs* only—$150
No cost-limit for non-specialty drugs

*Specialty drugs must be purchased through the plan's network specialty pharmacy, Ardon Health. See Prescription Cost-Limit for Specialty Drugs for more information on how this works.

Prescription drug deductible

TIP: Value Tier or Tier 1 drugs do not count toward your prescription drug deductible. If you get only Value Tier and Tier 1 drugs, you won’t need to pay the deductible.

Your annual prescription drug deductible is $100 per person (maximum of $300 for a family of three or more). You pay the deductible and your coinsurance to the pharmacy for Tier 2 and Tier 3 (brand-name) drugs. For drugs that cost less than $100, you pay the cost of the drug until you meet the $100 deductible in full.

The deductible applies regardless of where you purchase your prescription. Once you meet the prescription drug deductible, the plan pays benefits for the rest of the calendar year.

Prescription drug out-of-pocket limit

TIP: This puts a limit on how much each enrolled person pays for covered prescription drugs and products during a plan calendar year. It does not limit how much the plan pays.

The prescription drug out-of-pocket limit is $2,000 per person. There is no family maximum. Each member must meet their own prescription drug out-of-pocket limit separately.

After you reach this limit, the plan pays 100 percent of the allowed amount for covered drugs and products. If you receive prescription drugs from a non-network pharmacy that charges more than the allowed amount, you must still pay the difference (see #2 in the table below).

What counts toward my prescription drug out-of-pocket limit?
  • Your prescription drug coinsurance up to the prescription cost-limit (see chart above), when it applies.
  • Your prescription drug deductible.
What doesn’t count toward my prescription drug out-of-pocket limit?
  1. Amounts paid by the plan, including services covered in full (preventive).
  2. Amounts exceeding the allowed amount for drugs paid to non-network pharmacies.*
  3. Drugs and products not covered by the plan. See Guidelines for Drugs Not Covered.
  4. Costs for medical services, including drugs covered under the medical benefit. (See how the medical out-of-pocket limit works.)
  5. Costs paid for other enrolled family members’ prescription drugs and products.
What will I pay for after reaching my prescription drug out-of-pocket limit? You will still be responsible for paying numbers 2-5 above after you meet your individual prescription drug out-of-pocket limit.

*Non-network pharmacies may charge more than the allowed amount for prescription drugs. You are responsible for paying this amount in addition to your coinsurance.

Contact

UMP prescription drug customer service
Washington State Rx Services
Phone: 1-888-361-1611
TDD: 1-800-433-6313
Business hours: Monday-Friday 7:30 a.m. to 5:30 p.m. Pacific Time (PT)