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. Plus, the pharmacy sends the claim to the plan for you.
Remember to show your ID card at network pharmacies to get the plan discount. If you don't, you will have to pay the full cash price and submit a Prescription Drug Claim Form.
Many network retail pharmacies have vaccinating pharmacists able to provide preventive immunizations at no cost to you. Find network vaccination pharmacies.
At the mail-order pharmacy
Postal Prescription Services (PPS) is the plan's network mail-order pharmacy. Set up an account with PPS or call them at 1-800-552-6694. You may also call Washington State Rx Services (1-888-361-1611) for more information about mail order.
At non-network pharmacies
You can purchase your prescriptions (except specialty drugs) at a non-network pharmacy, but you'll pay more if you do. Non-network pharmacies won't know if a drug must be preauthorized or has other coverage limits. If you buy a drug from a non-network pharmacy and limits apply, the plan may not cover it.
You will need to submit your own claim for reimbursement, and you don't get the plan discount.
To transfer your prescriptions to a different pharmacy, contact the new pharmacy. Tell them which prescriptions you'd like to transfer, and make sure they have your insurance information. The new pharmacy will arrange the transfer.
Tip: You must have refills remaining to transfer a prescription. Since many pharmacies will automatically refill a transferred prescription, don't transfer yours until you are ready to fill them.
The plan will not cover a refill until 84 percent of the prior 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, 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.
The plan does not cover over-the-counter (OTC) drugs, vitamins, or supplements, though some OTC drugs are covered as exceptions (including some contraceptive devices and drugs). Read "Exceptions covered" on page 87 in your UMP Plus certificate of coverage to find out more.
If an OTC alternative drug is available, the plan does not cover the prescription drug. If you choose to use the prescription drug, you will pay the entire cost.
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 his/her 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 his/her 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 BlueShield 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
Business hours: customer service is available 24 hours a day, 7 days a week
Network mail-order pharmacy: Postal Prescription Services (PPS)
Fax (for providers only): 1-800-723-9023
Business hours: Monday-Friday 6 a.m. to 6 p.m. PT; Saturday 9 a.m. to 2 p.m. PT