implants, injectables, condoms, and spermicides. Final determination of medical necessity for FDA approved contraceptives is determined by the prescribing provider. Quantity limits still apply. You may purchase up to a 12-month supply of contraceptives. Contact Washington State Rx Services (WSRxS) Customer Service for information on how to obtain a 12-month supply. The replacement of lost, expired, or stolen contraceptives is not covered. You may obtain emergency contraception over-the-counter without a prescription. When possible, it is best to obtain a prescription, since not all pharmacies have prescribing authority. If you go to a pharmacy without a prescription and the pharmacy does not have prescribing authority, you will need to submit a claim to WSRxS. Members will need to contact the pharmacy directly for information on prescribing authority. Barrier devices All barrier devices requiring a prescription, fitting, insertion (includes IUD placement immediately after delivery), or removal are paid at the preventive rate when you see a preferred or participating provider or use a network pharmacy. Barrier devices requiring a prescription or fitting include intrauterine devices (IUDs), diaphragms, and cervical caps. Over-the-counter contraceptives Over-the-counter contraceptives are covered under the Preventive Tier (P) on the UMP Preferred Drug List (see “The UMP Preferred Drug List” section for more information), only if they are approved by and registered with the FDA. For the plan to cover FDA-registered over-the-counter contraceptives, you must present your UMP member ID card and make your purchase at the pharmacy counter. When possible, it is best to obtain a prescription, since not all pharmacies have prescribing authority. If you go to a pharmacy without a prescription and the pharmacy does not have prescribing authority, you will need to submit a claim to WSRxS. Sterilization When you see a preferred provider, sterilization procedures, such as tubal ligation or vasectomy, are covered as follows: • For females: Covered as preventive (not subject to your deductible and the plan pays 100 percent of the allowed amount). • For males: Paid at 100 percent after you meet your deductible. Services and products not covered under the family planning benefit The plan does not cover the following services and products as a family planning benefit: • Over-the-counter products not approved by and registered with the FDA • Reversal of voluntary sterilization • Treatment of fertility or infertility, including direct complications resulting from such treatment Foot care, maintenance Maintenance foot care includes services such as toenail trimming and corn or callous removal or trimming. These services are covered only for a diagnosis of diabetes and when provided by an approved provider type. The plan does not cover maintenance foot care provided outside the diagnosis of diabetes. Gender affirming care With a diagnosis of gender dysphoria, the following services are covered at the standard rate for outpatient services and at the inpatient rate for inpatient services: 52 2024 UMP CDHP (PEBB) Certificate of Coverage