What you pay for drugs

Now that you know how it works...

Find the cost for your drug

What you pay for prescription drugs under UMP Plus

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.

ALERT! The prescription drug benefit is managed by Washington State Rx Services and is the same for both UMP Plus networks. Call 1-888-361-1611 with questions about prescription drugs.
Tier All network pharmacies
Retail and mail-order
The most you'll pay
(prescription cost-limit)
Network pharmacies only
Value Tier 5% coinsurance $10—Up to a 30-day supply
$20—31-60 days’ supply
$30—61-90 days’ supply
Tier 1
Select generic drugs
10% coinsurance $25—Up to a 30-day supply
$50—31-60 days’ supply
$75—61-90 days’ supply
Tier 2
Preferred drugs
30% coinsurance $75—Up to a 30-day supply
$150—31-60 days’ supply
$225—61-90 days’ supply
Tier 3
Nonpreferred drugs
50% coinsurance 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 out-of-pocket limit

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
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

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)