Filling your prescriptions

For complete information, read "Your Prescription drug benefit" on page 72 in your certificate of coverage.

UMP Plus certificates of coverage

Where to purchase your prescription drugs

At a network pharmacy

You can visit any pharmacy to fill your prescriptions, but you will save money if you visit a network pharmacy. The pharmacy sends the claim to the plan for you, and you pay only your coinsurance.

Remember to show your ID card at network pharmacies to get the plan discount. If you do not, you will have to pay the full cash price and submit a Prescription Drug Claim Form.

Many network retail pharmacies have vaccination pharmacists who are able to provide 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.

At the mail-order pharmacy

Postal Prescription Services (PPS) is the plan's only network mail-order pharmacy. Prescriptions purchased through other mail order pharmacies may not be covered. Set up an account with PPS or call 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.

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. Non-network pharmacies will not know if a drug must be preauthorized or has other coverage limits. If you buy a prescription 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 do not get the plan discount.  Learn more about purchasing prescriptions from a non-network pharmacy.

Refilling your prescriptions too soon

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.

However, in the event of an emergency or other exigent circumstance, you may request an exception to override the refill too soon policy described above. The plan may require documentation to support your request. Approval of your request is at the sole discretion of the plan.

Learn about other limits on your drug coverage.

Emergency fill

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. A list of emergency prescription drugs is available at What you pay for drugs or by calling 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.

Note that the following limits still apply to emergency fill prescription drugs:

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 prescription 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.

Over-the-counter drugs, vitamins, and supplements

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 82 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.

Drugs purchased outside the U.S.

Alert: The plan does not cover prescription drugs purchased through mail-order pharmacies located 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 OTC 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.

Contact

Washington State Rx Services (network pharmacies)
Online: Your pharmacy account
Phone: 1-888-361-1611
TRS: 711
Business hours: 24 hours a day, 7 days a week

Postal Prescription Services (network mail-order pharmacy)
Online: Your PPS account
Phone: 1-800-552-6694
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)
Phone: 1-855-425-4085
TRS: 711
Business hours: Monday through Friday 8 a.m. to 7 p.m. and Saturday 8 a.m. to noon (Pacific)