Forms & publications

This ArrayRx document lists all anticipated changes to the UMP Preferred Drug List (PDL) effective April 1, 2025.

This is an ArrayRx 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.

This ArrayRx form may be included in an appeal or complaint regarding prescription drug coverage, but it is not required. It helps the member include all the necessary information for an appeal or complaint, and it includes the address and fax number where documents should be submitted.

This is a summary of how prescription drug benefits work for Uniform Medical Plan (UMP) Classic Medicare with Part D (PDP) plan for benefit year 2025, including what you'll pay for prescription drugs. UMP prescription drug benefits are administered by ArrayRx.

This is a summary of how prescription drug benefits work for Uniform Medical Plan (UMP) Classic (non-Medicare), UMP Select, UMP CDHP, and UMP Plus (PEBB) for benefit year 2025, including what you'll pay for drugs. UMP prescription drug benefits are administered by ArrayRx.

Teladoc Health Mental Health is a self-guided health and resiliency online tool for UMP members age 13 and older. This Regence brochure explains how to sign up for the Teladoc Health Mental Health tool.

This is an overview of new Uniform Medical Plan (UMP) benefits and changes to benefits for plan year 2025 for Public Employees Benefits Board (PEBB) Program members. UMP medical benefits are administered by Regence BlueShield and prescription drug benefits are administered by ArrayRx.

This document lists the 2024 and 2025 monthly premiums for Uniform Medical Plan (UMP) PEBB members who are employees and retirees. UMP is administered by Regence BlueShield and ArrayRx under contract with the Washington State Health Care Authority.

Preauthorization requirements for UMP plans (administered by Regence). This document includes: Guidelines, inpatient admissions, radiology, sleep, physical medicine, lab, maternity medicine, and genetic testing. Preauthorization is when you seek approval from your health plan for coverage of specific services, supplies, or drugs before receiving them. Some services or treatments (except emergencies) may require preauthorization before the plan pays for them. These criteria do not imply or guarantee approval. Please check with your plan to ensure coverage. Preauthorization requirements are only valid for the month published. They may have changed from previous months and may change in future months.

Preauthorization requirements for UMP plans (administered by Regence). This document includes: Substance use disorder, mental health, DME, surgery and transplants. Preauthorization is when you seek approval from your health plan for coverage of specific services, supplies, or drugs before receiving them. Some services or treatments (except emergencies) may require preauthorization before the plan pays for them. These criteria do not imply or guarantee approval. Please check with your plan to ensure coverage. Preauthorization requirements are only valid for the month published. They may have changed from previous months and may change in future months.