Therapeutic Interchange Program The Washington State Therapeutic Interchange Program allows a pharmacist to substitute a “therapeutic alternative” drug for a noncovered drug in certain cases. Therapeutic alternatives are drugs that are chemically different from your prescribed drug but provide the same therapeutic benefit. You may find out if your prescription drug is affected by the Therapeutic Interchange Program by checking the UMP Preferred Drug List on the UMP Prescription drug coverage webpage or by contacting WSRxS Customer Service (see Directory for link and contact information). The Therapeutic Interchange program does not affect all noncovered prescription drugs. The pharmacist will substitute the preferred drug when your prescribing provider has “endorsed” the Washington Preferred Drug List, and: • You are filling your prescription in Washington State or through UMP’s network mail-order pharmacies. • Your prescribing provider allows substitution on your prescription. If you do not want your prescription drug to be changed, the plan may not cover your drug if you ask the pharmacist to fill the prescription as written. Regardless of whether you or your prescribing provider ask the pharmacist to “dispense as written,” if you get the noncovered prescription drug, the plan may not cover it. The pharmacy will contact your provider to request authorization for the substitution. If approved by the provider, you will receive the alternative preferred drug along with a letter of explanation. If the pharmacy cannot get an authorization from your provider within 48 hours, the prescription will be filled as written, and you will be charged the full price of the drug. Travel overrides for prescription drugs You may request a travel override to get an extra supply of prescription drugs for extended travel. All of the conditions listed below apply. • You may request a travel override up to two weeks before your departure. • You may request no more than two travel overrides per calendar year, including all travel within or outside the U.S. • Within the U.S., you may request up to a 90-day supply per prescription, or as allowed under that prescription. • Outside the U.S., you may request up to a six-month supply per prescription, or as allowed under that prescription. • Travel overrides will be granted only while you are covered by the plan. If your eligibility is ending, the plan does not cover prescription drugs past the time your enrollment in the plan ends. • You will pay applicable charges (deductible and coinsurance) for each extra supply received. To request a travel override, contact WSRxS Customer Service. Refill too soon The plan will not cover a refill until 84 percent of the last prescription should be used up. Claims for therapeutic equivalents of the previously prescribed drug will also be denied. This also applies if your prescription is damaged, destroyed, lost, or stolen. For example, if you get a 90-day supply and you try to refill this prescription before 76 days have passed, coverage will be denied. However, in the event of an emergency or other urgent circumstance, you may request an exception to override the refill too soon policy. The plan may require documentation to support your request. Approval of your request is at the sole discretion of the plan. 2024 UMP CDHP (PEBB) Certificate of Coverage 101