What you pay for drugs

Now that you know how it works...

Find the cost for your drug

Cost depends on drug tier

How much you pay depends on the tier your prescription drug is in.

Note: You do not pay a deductible for prescription drugs, and prescription drug costs don’t count toward your medical deductible.

You may get up to a 90-day supply for most drugs—except for specialty drugs, which are usually limited to a maximum 30-day supply.

Note: The prescription drug benefit is managed by Washington State Rx Services and is the same for both UMP Plus networks. Call 1-888-361-1611 with questions about prescription drugs.

Tier All network pharmacies
Retail and mail-order
The most you'll pay
(prescription cost-limit)
Network pharmacies only
Value Tier 5% coinsurance

$10—Up to a 30-day supply
$20—31-60 days’ supply
$30—61-90 days’ supply

Tier 1
Select generic drugs
10% coinsurance

$25—Up to a 30-day supply
$50—31-60 days’ supply
$75—61-90 days’ supply

Tier 2
Preferred drugs
30% coinsurance

$75—Up to a 30-day supply
$150—31-60 days’ supply
$225—61-90 days’ supply

Tier 3
Nonpreferred drugs
50% coinsurance

Specialty drugs* only: $150
No cost-limit for non-specialty drugs

*Specialty drugs must be purchased through the plan's network specialty pharmacy, Ardon Health.

See an example of how the prescription cost-limit works in your certificate of coverage.

What you pay for specialty drugs

Specialty drugs are high-cost drugs that need special handling and are subject to special rules. They require preauthorization and are covered only when purchased through the plan's network specialty drug pharmacy, Ardon Health.

If you are prescribed a specialty drug, call Ardon Health at 1-855-425-4085. They will provide individualized help to get you the drug you need.

Learn about specialty drugs, including how much you'll pay for them, in your UMP Plus-PSHVN or UMP Plus-UW Medicine ACN Certificate of Coverage.

Note: You can find out if a drug is a specialty drug by checking the UMP Preferred Drug List or calling Washington State Rx Services.

Prescription drug out-of-pocket limit

TIP: This limits 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.

For each person enrolled in UMP Plus, the prescription drug out-of-pocket limit is $2,000 per person, with no family maximum. Each member must meet their own prescription drug out-of-pocket limit separately.

Your prescription drug coinsurance up to the prescription cost-limit (see chart above), when it applies, counts toward this limit.

The following does not count toward the out-of-pocket limit:

  1. Amounts paid by the plan, including services covered in full (preventive).
  2. Amounts exceeding the allowed amount for drugs paid to non-network pharmacies. (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.)
  3. Drugs and products not covered by the plan. See "Guidelines for Drugs Not Covered" in your certificate of coverage.
  4. Costs for medical services, including drugs covered under the medical benefit. (See how the medical out-of-pocket limit works.)
  5. Costs paid for other enrolled family members’ prescription drugs and products.

You will still be responsible for paying numbers 2-5 above after you meet your individual prescription drug out-of-pocket limit.

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.

Contact

Washington State Rx Services
Phone: 1-888-361-1611
TDD: 1-800-433-6313
Business hours: Monday-Friday 7:30 a.m. to 5:30 p.m. Pacific Time (PT)