• Specialty drugs must be purchased from the plan’s network specialty drug pharmacy. See the “Specialty drug” section on page 101. TIP: To submit claims for prescriptions purchased from non-network pharmacies (U.S. retail or international retail pharmacies), see the “Submitting a claim for prescription drugs” section. Prescription drugs purchased outside the U.S. If you purchase prescription drugs outside the U.S. for any reason, the following rules apply: • If the prescription drug is available only by prescription in the U.S. but does not require one outside the U.S., the drug is covered only if prescribed by a provider practicing within their scope of practice. • If you get a prescription drug that is approved for use in another country but not in the U.S., the plan will not cover it. • If you get a prescription drug that is available over-the-counter in the U.S., the plan will not cover the drug, even if you have a prescription from a provider prescribing within their scope of practice. The plan does not cover most over-the-counter drugs. • If you get a prescription drug that is not covered by UMP, the plan will not pay any amount of the cost of the drug. You will be responsible for the full cost of the drug. To submit a claim for a prescription drug purchased at retail pharmacies outside the U.S., see the “Submitting a claim for prescription drugs” section. All necessary information must be included on the prescription drug claim form with drugs and dosage documented. Limits on your prescription drug coverage WSRxS may exclude, not cover, discontinue, or limit coverage for any prescription drug or manufacturer’s version of a drug — or shift a drug to a different tier, or to noncovered or excluded status — for any of the following reasons: • A more cost-effective alternative is available to treat the same condition. • A nonprescription alternative, including an over-the-counter alternative, becomes available. • A prescription drug receives FDA approval for a new use. • A prescription drug is used off label to treat an indication that is not determined to be medically necessary by WSRxS. • A prescription drug is purchased from an excluded pharmacy. • Generic, biosimilar, interchangeable biosimilar, or follow-on biologic prescription drugs become available. • New prescription drugs are developed. • The FDA denies, withdraws, or limits the approval of a prescription drug. • The FDA’s Drug Efficacy Study Implementation (DESI) classifications finds a prescription drug to be less than effective. • The Washington State P&T Committee or WSRxS recommends a change (see the "How UMP decides which prescription drugs are preferred" section). • There is a sound medical reason. 2024 UMP Select (PEBB) Certificate of Coverage 99