Filling your prescriptions

For complete information, read "Your prescription drug benefit" in your certificate of coverage (COC).

UMP CDHP COC

Where to fill your prescriptions

At a network pharmacy

You can visit any pharmacy, but you will save money if you fill your prescriptions at a network pharmacy. Plus, the pharmacy sends the claim to the plan for you and you pay only what you owe.

Before meeting your deductible, this will be the allowed amount for a covered drug. After you have met your deductible, you will pay 15 percent of a covered drug’s allowed amount. Note: You will pay the entire cost for any drug not covered by the plan, which will not apply toward either your deductible or your out-of-pocket limit.

Remember to show your ID card at network pharmacies to get the plan discount. If you don't, you will have to pay the full price and submit a Prescription Drug Claim Form.

Many network pharmacies have vaccinating pharmacists able to provide preventive immunizations at no cost to you. Find network vaccination pharmacies.

Note: To make sure you pay the right amount for your prescriptions, always show your UMP ID card first. If you have a prescription drug discount card, show that card second to see if you can get a discount on prescriptions UMP does not cover.

At the mail-order pharmacy

Postal Prescription Services (PPS) is the plan's network mail-order pharmacy. Set up an account with PPS or call them at 1-800-552-6694. You may also call Washington State Rx Services (1-888-361-1611) for more information about mail order.

Tip: You can use your Medical Flexible Spending Arrangement (FSA) debit card for prescription drug purchases through PPS or Ardon Health, the specialty drug pharmacy.

At non-network pharmacies

You can purchase your prescriptions (except specialty drugs) at a non-network pharmacy, but you'll pay more if you do. You will need to submit your own claim to Washington State Rx Services for reimbursement, and you don't get the plan discount. Learn more about purchasing prescriptions from a non-network pharmacy.

How to transfer your prescriptions

To transfer your prescriptions to a different pharmacy, contact the new pharmacy. Tell them which prescriptions you'd like to transfer, and make sure they have your insurance information. The new pharmacy will arrange the transfer.

Tip: You must have refills remaining to transfer a prescription. Since many pharmacies will automatically refill a transferred prescription, don't transfer yours until you are ready to fill them.

Refilling your prescriptions too soon

The plan will not cover a refill until 84 percent of the previous prescription should be used up. Claims for therapeutic equivalents of the previously prescribed drug will also be denied. This also applies if your prescription is destroyed, lost, expired, or stolen.

For example, if you get a 90-day supply and you try to refill this prescription before 76 days have passed, coverage will be denied.

Learn about other limits on your drug coverage.

Over-the-counter drugs, vitamins, and supplements

The plan does not cover over-the-counter (OTC) drugs, vitamins, or supplements, though some OTC drugs are covered as exceptions. If an OTC alternative drug is available, the plan does not cover the prescription drug. If you choose to use the prescription drug, you will pay the entire cost.

Drugs purchased outside the U.S.

Alert: The plan does not cover prescription drugs purchased through mail-order pharmacies located outside the U.S.

If you purchase drugs outside the U.S. for any reason, the following rules apply:

  • If the drug is available only by prescription in the U.S. but does not require one outside the U.S., the drug is covered only if prescribed by a provider practicing within his/her scope of practice.
  • If you get a drug that is approved for use in another country but not in the U.S., the plan will not cover it.
  • If you get a drug that is available over-the-counter in the U.S., the plan will not cover the drug, even if you have a prescription from a provider prescribing within his/her scope of practice. The plan does not cover over-the-counter drugs except for certain preventive medicines as required by the Accountable Care Act. These drugs are indicated with a “PV” in the UMP Preferred Drug List.
  • If you get a drug that is designated as not covered in the UMP Preferred Drug List, the plan will not cover the drug.

Learn how to submit a claim for a prescription drugs. All necessary information must be included on the prescription drug claim, with drugs and dosage documented. Regence works with the BlueCard (Global Core) Service Center to translate claims, services, and account for currency differences on all claims submitted by you or your provider.

Contact

Washington State Rx Services
Phone:
 1-888-361-1611
TRS: 711
Business hours: 24 hours a day, 7 days a week

Network mail-order pharmacy: Postal Prescription Services (PPS)
Phone: 1-800-552-6694
Fax (for providers only): 1-800-723-9023
Business hoursMonday-Friday 6 a.m. to 6 p.m. PT; Saturday 9 a.m. to 2 p.m. PT