Mail-order pharmacies: Costco Mail-Order Pharmacy and Postal Prescription Services (PPS) ALERT! UMP’s network mail-order pharmacies cannot ship outside of the U.S. See “Travel overrides for prescription drugs” on page 102 if you will be traveling. Costco Mail-Order Pharmacy and PPS are the plan’s only network mail-order pharmacies. Prescriptions purchased through other mail-order pharmacies will not be covered if UMP is your primary plan. For more information about mail-order, visit the UMP Prescription drug coverage webpage, contact UMP’s network mail-order pharmacies, or contact WSRxS Customer Service. See the Directory pages at the beginning of this booklet for links and contact information. Note: You may mail in a prescription, however only a provider can call, fax, or electronically submit a prescription to the pharmacy. You must follow these instructions to avoid a delay in filling your prescription. ALERT! The plan does not cover other mail-order pharmacies outside of UMP’s network mail- order pharmacies if UMP is your primary insurance. If UMP is your secondary insurance, you may use another mail-order pharmacy. Refills may be ordered through UMP’s network mail-order pharmacies. When using UMP’s network mail- order pharmacies, the same prescription drug coinsurance, preauthorization requirements, and limits on coverage apply as for prescription drugs purchased at retail network pharmacies. ALERT! Drugs can be expensive. If you are not able to be home to receive the drug in the mail, it may be a good idea to request that it be sent with a requirement for a signature, or find an alternate point of delivery to ensure the package is not stolen. The plan is not responsible for replacement of lost, stolen, expired, or damaged prescription drugs or products (see the “What the plan does not cover” section). Because of increased volume at the end of the year, prescriptions submitted to the network mail-order pharmacies in December may not be processed during the current plan year. If there is a shortage of a specific prescription drug that UMP’s network mail-order pharmacies cannot control, and it does not have the quantity you ordered, the network mail-order pharmacies will contact you to discuss your options for obtaining your prescription(s). ALERT! Some Durable Medical Equipment (DME) items are not available through UMP’s network mail-order pharmacies. You will need to get them through a network retail pharmacy or network DME provider. 2024 UMP Plus–UW Medicine ACN (PEBB) Certificate of Coverage 95