What you pay for drugs
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How much you pay depends on the tier your prescription drug is in. The prescription drug deductible applies to Tier 2 and Tier 3 drugs as indicated in the table below.
You can get up to a 90-day supply for most drugs—except for specialty drugs, which are usually limited to a maximum 30-day supply.
|Tier||All network pharmacies
Retail and mail-order
|The most you'll pay
Network pharmacies only
|Value Tier||5% coinsurance
|$10—Up to a 30-day supply
$20—31-60 days’ supply
$30—61-90 days’ supply
Select generic drugs
|$25—Up to a 30-day supply
$50—31-60 days’ supply
$75—61-90 days’ supply
|$75—Up to a 30-day supply
$150—31-60 days’ supply
$225—61-90 days’ supply
|Specialty drugs* only—$150
No cost-limit for non-specialty drugs
TIP: Value Tier or Tier 1 drugs do not count toward your prescription drug deductible. If you get only Value Tier and Tier 1 drugs, you won’t need to pay the deductible.
Your annual prescription drug deductible is $100 per person (maximum of $300 for a family of three or more). You pay the deductible and your coinsurance to the pharmacy for Tier 2 and Tier 3 (brand-name) drugs. For drugs that cost less than $100, you pay the cost of the drug until you meet the $100 deductible in full.
The deductible applies regardless of where you purchase your prescription. Once you meet the prescription drug deductible, the plan pays benefits for the rest of the calendar year.
TIP: This puts a limit on how much each enrolled person pays for covered prescription drugs and products during a plan calendar year. It does not limit how much the plan pays.
The prescription drug out-of-pocket limit is $2,000 per person. There is no family maximum. Each member must meet their own prescription drug out-of-pocket limit separately.
After you reach this limit, the plan pays 100 percent of the allowed amount for covered drugs and products. If you receive prescription drugs from a non-network pharmacy that charges more than the allowed amount, you must still pay the difference (see #2 in the table below).
|What counts toward my prescription drug out-of-pocket limit?||
|What doesn’t count toward my prescription drug out-of-pocket limit?||
|What will I pay for after reaching my prescription drug out-of-pocket limit?||You will still be responsible for paying numbers 2-5 above after you meet your individual prescription drug out-of-pocket limit.|
*Non-network pharmacies may charge more than the allowed amount for prescription drugs. You are responsible for paying this amount in addition to your coinsurance.
UMP prescription drug customer service
Washington State Rx Services
Business hours: Monday-Friday 7:30 a.m. to 5:30 p.m. Pacific Time (PT)