You may get nicotine replacement therapy directly from the tobacco cessation program (see the “Tobacco cessation program” section below), or by following these steps: 1. Get a prescription from your provider. 2. Take the prescription to a network pharmacy. 3. Make your purchase at the pharmacy counter of a network pharmacy. Give your prescription and your UMP member ID card to the pharmacist. The purchase must be submitted through the prescription drug system to be covered. If you do not provide a valid prescription at the pharmacy counter, the plan will not cover it. If you get a nicotine replacement therapy product not designated as preventive, the plan will not cover it, and you will pay the full cost. To request full coverage of non-preventive nicotine replacement therapy for a medical reason, see “How to request an exception” below. The plan does not cover e-cigarettes or vaporizers (“vapes”). Counseling The plan covers in-person counseling related to tobacco cessation at the preventive rate when you see a preferred or participating provider. Phone or online counseling is covered only through the Tobacco cessation program described below. UMP members ages 17 and under may use the Smokefree Teen program as explained below. How to request an exception To request coverage of a prescription drug or nicotine replacement therapy not usually covered under this benefit, see “Requesting an exception for noncovered prescription drugs” on page 89 for how to request an exception. If your exception is approved, you will receive the approved product or prescription drug at no cost. Tobacco cessation program UMP members age 18 or older may participate in the tobacco cessation program. The program offers a variety of resources, including phone counseling, medications, personalized coaching, web tools, educational materials, nicotine replacement therapy, and other resources to help you stop tobacco use. It also offers a free personalized quit plan and has been proven to help individuals quit more successfully than trying to quit without support. To learn more, visit the UMP Care programs webpage at ump.regence.com/pebb/benefits/programs. If you get nicotine replacement therapy or prescription drugs for tobacco cessation that are not listed as “Preventive” in the Tier column on the UMP Preferred Drug List, you will pay as described in the “Nicotine replacement therapy” section on page 75. For nicotine replacement therapy, you may get supplies sent to you from the program or get a prescription from your provider and purchase as described under “Nicotine replacement therapy” on page 75. ALERT! You may attest for an exemption to the PEBB tobacco use premium surcharge if you or a dependent are tobacco-free for two months, enroll in the tobacco cessation program (for members age 18 or older), or access the information and resources aimed at teens in Smokefree Teen (for members ages 13 through 17). Visit the HCA website at hca.wa.gov/erb for details about the surcharge. 76 2024 UMP CDHP (PEBB) Certificate of Coverage