Your prescription drug benefit See the Directory for prescription drug contact information. Your plan’s prescription drug benefit is managed by a partnership of companies known as Washington State Rx Services (WSRxS): • Preauthorization, appeals, and customer service: Moda Health • Network mail-order pharmacies: ▪ Costco Mail-Order Pharmacy ▪ Postal Prescription Services (PPS) ▪ Note: The plan does not cover prescription drugs purchased through mail-order pharmacies located outside the U.S. • Network specialty drug pharmacy: Ardon Health Visit the UMP Prescription drug coverage webpage to: • Find a link to the UMP Preferred Drug List and the Drug Price Check tool. • Find a link to your online pharmacy account. • Find information on mail-order and specialty drugs. • Learn about submitting prescription drug claims. • Locate network pharmacies or network vaccination pharmacies. • Review prescription drug policies and programs. Contact the mail-order or specialty drug pharmacy directly for help placing or tracking prescription orders. If additional help is needed, contact WSRxS Customer Service. Note: Regence BlueShield does not provide prescription drug benefits for UMP. Always contact WSRxS with questions about your prescription drug coverage. TIP: The UMP Preferred Drug List is available on the UMP Prescription drug coverage webpage (see Directory for link). On this webpage, you will also find a link to the Drug Price Check tool (the prices for drugs listed in this tool assume you have met your deductible). The UMP Preferred Drug List The UMP Preferred Drug List (sometimes called a “formulary”) lists all of the preferred drugs that UMP covers. Drugs not listed on the Preferred Drug List are not covered unless an exception is requested and approved by UMP. Excluded prescription drugs and products are not eligible for an exception. For the exception process, refer to “Requesting an exception for noncovered prescription drugs” on page 89. The UMP Preferred Drug List includes: • If the plan must preauthorize a prescription drug (see page 98) • If you must purchase a prescription drug from the plan’s network specialty drug pharmacy (see page 99) • If there are any limits on a prescription drug’s coverage (see the "Limits on your prescription drug coverage" section) 2024 UMP CDHP (PEBB) Certificate of Coverage 87