prescription for a Step 2 drug, the plan will not cover your prescription. When this happens, your provider will need to prescribe the Step 1 drug for you. If you or your provider feels that you need the Step 2 prescription filled as originally written without first trying the Step 1 drug, your pharmacist or prescribing provider may contact WSRxS Customer Service and request coverage. You will have to pay the entire cost of the prescription drug if you have not tried the Step 1 drug and coverage has not been authorized before you get the Step 2 drug. To find out if step therapy applies to your drug, check the UMP Preferred Drug List on the UMP Prescription drug coverage webpage, or contact WSRxS Customer Service (see Directory for link and contact information). Note: Only network pharmacies will check to see if step therapy applies to your prescription drug. If you get a step therapy drug at a non-network pharmacy, the plan may not cover the drug. Substitution under Washington State law ALERT! New generic prescription drugs are released throughout the year. If you want to save money by using generics, ask your provider to allow substitution on your prescriptions, even if a generic drug is not available now. That way, when one becomes available, the pharmacist may automatically refill with the generic. When a brand-name or biologic prescription drug has a generic equivalent or interchangeable biosimilar, pharmacists in Washington State must substitute the generic equivalent or interchangeable biosimilar drug for the brand-name or biologic prescription drug. When a generic equivalent for a brand-name prescription drug becomes available, the brand-name drug immediately becomes noncovered. Your provider may write the prescription “dispense as written” if they want you to get only the prescribed brand-name or biologic prescription drug. Or you may tell the pharmacist you want the brand-name or biologic drug. 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. Final determination of medical necessity for FDA-approved contraceptives is determined by the attending prescribing provider. To request an exception for a noncovered drug, see page 87. 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. 2024 UMP Plus–PSHVN (PEBB) Certificate of Coverage 101