• How much your cost share will be based on the drug tier • 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) • If there are less expensive alternatives The UMP Preferred Drug List is updated online throughout the year, and how a prescription drug is covered may change at any time. You may look up your prescription drugs online on the UMP Prescription drug coverage webpage or by contacting WSRxS (see Directory for link and contact information). New brand-name prescription drugs may not be covered during the first 180 days they are available. To check if a new prescription drug is covered, contact WSRxS Customer Service. Preferred drugs Preferred drugs, including preferred specialty drugs, have been reviewed by the Washington State Pharmacy and Therapeutics (P&T) Committee or by WSRxS and found to be safe and clinically effective when compared to other drugs in the same therapeutic class or category. HCA or WSRxS has found these drugs to be among the most cost-effective drugs for their therapeutic class or category due to their favorable pricing. Noncovered prescription drugs Noncovered prescription drugs are not covered unless a Preferred Drug List exception is requested and approved (see “Requesting an exception for noncovered prescription drugs”). These prescription drugs have been reviewed by the Washington State Pharmacy and Therapeutics (P&T) Committee or WSRxS. HCA or WSRxS has found these drugs are not as cost-effective and do not have a clinically significant therapeutic advantage over the Preferred Drug List alternative(s). ALERT! When a generic equivalent for a brand-name prescription drug becomes available, the brand-name drug immediately becomes noncovered. An exception must be requested and approved for coverage of the brand-name drug if you want to continue using the brand-name drug. Always ask your provider to allow substitution on your prescriptions to save you money. See the “Substitution under Washington State law” section for more information on transitioning from a brand-name to generic prescription drug. Requesting an exception for noncovered prescription drugs ALERT! The UMP Preferred Drug List may not show every alternative prescription drug you must try before an exception may be granted. If your exception request is denied, the plan’s response letter will include the reason for the denial and the steps you can take next. If you are prescribed a noncovered drug, and you have tried all the alternative drugs and none are found to be effective, or if the alternatives are found to not be medically appropriate, you or your prescribing provider can request an exception by contacting WSRxS Customer Service. 86 2024 UMP Plus–PSHVN (PEBB) Certificate of Coverage