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. When you get your prescriptions at a network pharmacy, 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.

Many network pharmacies have vaccination pharmacists who are 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.

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.

At the mail-order pharmacy

Postal Prescription Services (PPS) is the plan's only 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 at 1-888-361-1611 (TRS: 711) for more information about mail order.

At non-network pharmacies

You can purchase your prescriptions (except specialty drugs) at a non-network pharmacy, but you will pay more if you do. If you get your prescriptions filled at a non-network pharmacy, whether a retail, internet, or mail-order pharmacy (other than PPS), the following applies:

  • You will need to submit your own claim to Washington State Rx Services for reimbursement.
  • You do not get the plan discount.
  • You will pay the difference between the allowed amount and what the pharmacy charges, and it will not count toward your deductible or out-of-pocket limit.
  • Non-network pharmacies will not know if a drug must be preauthorized, has a quantity limit, or has other coverage limits. If you purchase a drug from a non-network pharmacy and limits apply, the plan may not cover it.
  • Unless noted on the UMP Preferred Drug List, specialty drugs purchased anywhere but through the plan’s network specialty drug pharmacy are not covered.

If you use a non-network pharmacy or do not show your ID card at a network pharmacy, and the amount charged is more than the allowed amount, you will pay the difference in addition to your coinsurance. Learn more about purchasing prescriptions from a non-network pharmacy.

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.

Emergency fill

Emergency fill lets you get a limited quantity of certain drugs while the plan processes your preauthorization request. This option is only available when a delay could result in emergency care, hospital admission, or a serious threat to your health or others in contact with you.

Get a list of emergency prescription drugs or call Washington State Rx Services at 1-888-361-1611 (TRS: 711).

  • You must bring your prescription to a network pharmacy and state that you need an emergency fill while the plan processes your preauthorization request. You pay 15 percent of the prescription drug’s allowed amount after you meet your deductible. You pay the full amount of the prescription drug before you meet your deductible.
  • The plan will cover an emergency fill of up to a 7-day prescription drug supply; preauthorization requests are usually resolved within three to five business days.
  • If your preauthorization request is denied, you will pay the full cost of the drug for any quantity you receive after the emergency fill.

Refill too soon: If you have a filled prescription for a prescription drug (or its therapeutic equivalent), you cannot get an emergency fill until you have used 84 percent or more of the filled prescription

Quantity limits: You cannot get more than the stated quantity limit under an emergency fill. If you have a current filled prescription for a prescription drug (or its therapeutic equivalent) and it was filled to the quantity limit, you cannot get an emergency fill until you have used 84 percent or more of the filled prescription. Learn about quantity limits.

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 their 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 their 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 identified 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
Online:
Your pharmacy account
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)
Online: Your PPS account
Phone: 1-800-552-6694
Fax (for providers only): 1-800-723-9023
Business hoursMonday through Friday 6 a.m. to 6 p.m. and Saturday 9 a.m. to 2 p.m. (Pacific)