Prescription drugs and Medicare

Use network pharmacies that bill directly

To get the most from your prescription drug coverage, we recommend that you choose a network pharmacy that can bill Medicare Part B directly. Medicare Part B does cover a few drugs and supplies for specific purposes; they are identified on the UMP Preferred Drug ListNote: Medicare Part B quantity restrictions may apply.

Medicare accepts claims only from pharmacies, not from individuals. If Medicare covers a drug or supply and the pharmacy doesn't send the claim to Medicare first for payment, UMP Classic will reject the claim. To find a network retail pharmacy, see the pharmacy locator or call Washington State Rx Services at 1-888-361-1611.

Drugs or supplies covered under Medicare Part B are paid as medical. When paying secondary to Medicare Part B, UMP Classic also pays under the medical benefit. Therefore, these charges are subject to the medical deductible.

Alert! UMP's network mail-order pharmacy, PPS, cannot bill Medicare for you when Medicare is your primary coverage. You must submit a claim to Washington State Rx Services after Medicare has paid its share.

UMP Classic and Medicare Part D

You cannot enroll in both UMP Classic and a Medicare Part D prescription drug plan. UMP Classic provides your prescription drug coverage and you may not have both. Medicare will notify the PEBB program if you enroll in a Part D plan while enrolled in UMP Classic. You could lose your eligibility for PEBB coverage if you do this. If you think you want a Part D prescription drug plan, you must change your medical plan from UMP Classic to Medicare Supplement Plan F.

See "Medicare Part D" on page 167 of the UMP Classic Certificate of Coverage for more information. Contact the PEBB Program at 1-800-200-1004 for more information and assistance.

Diabetes care supplies when Medicare pays first

Medicare pays claims for some diabetes care supplies under the Part B medical benefit. As a result, UMP Classic pays the claim under the durable medical equipment benefit, not the prescription drug benefit. This means you will have to meet your medical deductible before UMP Classic begins to pay on diabetes care supplies claims. Then, UMP Classic pays its share based on medical benefit coinsurance (85% of the allowed amount for providers that accept Medicare).

Contact

Uniform Medical Plan (Regence)

Phone: 1-888-849-3681
TTY: 711
Business hours: Monday–Friday 7 a.m. to 5 p.m. Pacific Time (PT)