Forms & publications

This form is for notifying Washington State Rx Services (WSRxS) that you have prescription drug coverage in addition to Uniform Medical Plan (UMP).

This Uniform Medical Plan (UMP) form is for provider use. This form is required when patients are using opioids chronically or when daily opioid doses reach 120 MME or greater. This form may authorize use for a maximum of 12-months. Washington State Rx Services (WSRxS) created this form.

This claim form can be used to request reimbursement for over the counter COVID-19 at home tests.

These instructions outline how UMP members can access COVID-19 at home test kits from Costco pharmacy.

This document is the 2024 Preferred Drug List (PDL) for the Uniform Medical Plan (UMP). This 2024 PDL will apply to all UMP plans for PEBB and SEBB members. It lists prescription drugs covered by UMP. The prescription drug benefit is administered by Washington State Rx Services (WSRxS).

This Washington State Rx Services (WSRxS) document lists all anticipated changes to the UMP Preferred Drug List (PDL) effective January 1, 2023.

This Washington State Rx Services (WSRxS) document lists all anticipated changes to the UMP Preferred Drug List (PDL) effective November 1, 2023.

This Washington State Rx Services (WSRxS) document lists all anticipated changes to the UMP Preferred Drug List (PDL) effective March 1, 2024.

This Washington State Rx Services (WSRxS) document lists all anticipated changes to the UMP Preferred Drug List (PDL) effective April 1, 2024.

This is a Washington State Rx Services (WSRxS) claim form for reimbursement for prescription drugs for Uniform Medical Plan (UMP) members. Members might use this form if they purchased drugs at nonnetwork pharmacies or have other prescription coverage that pays first and UMP is secondary. Members might also use this form if they fail to show their ID at a network pharmacy or get a prescription from a mail-order or internet pharmacy other than Costco Mail-Order Pharmacy or Postal Prescription Services.