Preauthorization Preauthorization is plan approval for coverage of specific services, supplies, or prescription drugs before they are provided to the member. Preauthorization is not a guarantee of coverage. If you or your provider do not receive preauthorization for certain medical services or prescription drugs, the plan may deny the claim. See the “Preauthorizing medical services” section for how this works. A list of medical services that require preauthorization is available on the UMP Policies that affect your care webpage or by contacting UMP Customer Service (see Directory for link and contact information). See page 98 for information on prescription drugs that must be preauthorized. Preferred drug A preferred drug is a prescription drug that is listed on the UMP Preferred Drug List. Preferred Drug List The UMP Preferred Drug List is a list available online that specifies how prescription drugs are covered by the plan. By using this list, you may find out if a prescription drug is covered, how much you will pay, if the drug must be ordered through the plan’s specialty drug pharmacy, and whether the drug has any limitations (such as needing preauthorization or quantity limits; see the ”Limits on your prescription drug coverage” section). The UMP Preferred Drug List is based on the Washington Preferred Drug List and recommendations by one of the P&T Committees that partner with WSRxS (see the “How UMP decides which prescription drugs are preferred” section for more information). Preferred provider(s) A preferred provider is a provider: • In the Regence service area and contracted as part of Regence BlueShield’s PPO network; or • Outside the Regence service area and contracted with another Blue Cross or Blue Shield organization in the BlueCard® Program (designated as a Provider in the “Preferred Provider Organization (“PPO”) Network”) to provide services and supplies to plan members. Preferred Provider Organization (PPO) A Preferred Provider Organization (PPO) is a health plan that has a network of providers who have agreed to provide services at discounted rates. Members may self-refer to most specialists. UMP CDHP is a PPO. Prenatal Prenatal means during pregnancy. Prescription drug Prescription drug means a drug approved by the FDA that can be dispensed only with an order given by a properly authorized person. The designation of a medication as a prescription drug is made by the FDA. Preventive care Preventive care means those services described by the Public Health Services Act, Section 2713: • Covered immunizations recommended by the CDC. 186 2024 UMP CDHP (PEBB) Certificate of Coverage