What you pay for drugs
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How much you pay depends on the tier your prescription drug is in.
Note: You do not pay a deductible for prescription drugs, and prescription drug costs don’t count toward your medical deductible.
You may 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
Network pharmacies only
|Value Tier||5% coinsurance||
$10—Up to a 30-day supply
$20—31-60 days’ supply
$30—61-90 days’ supply
Select generic drugs
$25—Up to a 30-day supply
$50—31-60 days’ supply
$75—61-90 days’ supply
$75—Up to a 30-day supply
$150—31-60 days’ supply
$225—61-90 days’ supply
Specialty drugs* only: $150
No cost-limit for non-specialty drugs
TIP: This limits 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.
For each person enrolled in UMP Plus, the prescription drug out-of-pocket limit is $2,000 per person, with 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.|
|What doesn’t count toward my prescription drug
|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.
Washington State Rx Services
Business hours: Monday-Friday 7:30 a.m. to 5:30 p.m. Pacific Time (PT)