Prescription drugs and Medicare

Use network pharmacies that bill Medicare Part B directly

Most 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.

For those drugs and medical supplies covered under your prescription drug benefit, we recommend that you choose a network pharmacy that can bill Medicare Part B directly to get the most from your prescription drug coverage. Medicare Part B does cover a few drugs and supplies for specific purposes. These drugs and supplies are identified on the UMP Preferred Drug List. Note: 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, use the pharmacy locator or call Washington State Rx Services at 1-888-361-1611 (TRS: 711).

Alert: UMP's network mail-order pharmacy, Postal Prescription Services (PPS), cannot bill Medicare for you when Medicare is your primary coverage. You must submit a claim to Washington State Rx Services only 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" in your certificate of coverage for more information. Contact the PEBB Program at 1-800-200-1004 (TRS: 711) to ask when and how you can change your PEBB medical plan.

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 percent of the allowed amount for providers that accept Medicare). See also the “Diabetes care supplies” section in your certificate of coverage for more about this benefit.

Contact

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