Filling your prescriptions
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At a network pharmacy
You can visit any pharmacy to fill your prescriptions, but you will save money if you visit 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 your cost-share (coinsurance and prescription drug deductible).
Many network retail pharmacies have vaccinating pharmacists who are able to provide covered 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.
If you use a non-network pharmacy of any type, you will pay the entire cost of the drug upfront and must submit a Prescription Drug Claim Form. However, only the allowed amount for covered prescription drugs will count toward your prescription drug deductible or prescription drug out-of-pocket limit.
At the mail-order pharmacy
Postal Prescription Services (PPS) is the plan's only network mail-order pharmacy. You can have your prescriptions filled and delivered to any location in the United States by setting up an account with PPS or calling 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.
When you use PPS, the same deductible, coinsurance, preauthorization requirements, and limits apply as when you use a network pharmacy.
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. You do not get the plan discount and will need to submit your own claim to the plan. Learn more about purchasing prescriptions from a non-network pharmacy.
The plan will not cover a refill until 84 percent of the last 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 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 your coinsurance under the drug’s tier.
- 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 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 more about quantity limits.
The plan does not cover over-the-counter (OTC) drugs, vitamins, or supplements, except certain preventive medicines as required by the Accountable Care Act. These drugs are indicated with a “PV” in the UMP Preferred Drug List. Some products are also covered as exceptions.
Prescription drugs with a nonprescription alternative — including an over-the-counter alternative having similar safety, efficacy, and ingredients — are not covered.
Alert: The plan does not cover prescription drugs purchased through mail-order pharmacies 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 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 form 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.
Washington State Rx Services (network pharmacies)
Online: Your pharmacy account
Business hours: 24 hours a day, 7 days a week
Postal Prescription Services (network mail-order pharmacy)
Online: Your PPS account
Business hours: Monday through Friday 6 a.m. to 6 p.m. and Saturday 9 a.m. to 2 p.m. (Pacific)
Ardon Health (network specialty drug pharmacy)
Business hours: Monday through Friday 8 a.m. to 7 p.m. and Saturday 8 a.m. to noon (Pacific)