What you pay for drugs
On this page
After you meet your deductible, you pay 15 percent of the allowed amount for covered prescriptions.
You can get up to a 90-day supply for most drugs, except for specialty drugs. Most covered prescription drugs count toward your deductible and out-of-pocket limit. If a drug isn't covered by the plan, it does not count toward your deductible or out-of-pocket limit.
Note: You may use your Health Savings Account to pay for drugs, even those not covered by the plan.
When you use network pharmacies, you pay based on the drug's allowed amount, a discounted price negotiated for the plan. Plus, the pharmacy submits the claim to the plan for you, which counts toward your deductible and out-of-pocket limit.
If you use a non-network pharmacy, they may charge more than the plan allowed amount. Only the allowed amount counts toward your deductible or out-of-pocket limit. Any amount that exceeds the allowed amount does not count.
Also, a non-network pharmacy may not submit claims on your behalf. You must submit a claim to the plan to count toward your deductible or out-of-pocket limit.
If you are enrolled in Medicare Part B and Medicare is your primary coverage, we suggest you choose a network pharmacy that can bill Medicare Part B directly. To find one, use the pharmacy locator or call Washington State Rx Services at 1-888-361-1611.
Medicare accepts claims only from pharmacies, not members. Your pharmacy must send claims to Medicare before sending them to UMP CDHP.
Drugs or supplies covered under Medicare Part B are paid as medical. So, when UMP CDHP pays after Medicare Part B, UMP CDHP also pays under the medical benefit.
Note: The UMP mail-order pharmacy, PPS, cannot bill Medicare for you when Medicare is your primary coverage. You must submit a prescription drug claim to Washington State Rx Services after Medicare has paid its share.
Washington State Rx Services (for questions about prescription drugs)
Business hours: Monday-Friday 7:30 a.m. to 5:30 p.m. Pacific Time