Example: If your specialty drug is Tier 2 and you receive a 45-day supply, the most you will pay (prescription cost-limit) is $150 (standard 30-day limit $75 x 2=$150). Step therapy ALERT! If a Step 1 or Step 2 drug is approved for coverage by WSRxS, you will pay the applicable cost-share of that prescription drug according to its tier in the UMP Preferred Drug List. When a prescription drug is part of the step therapy program, you have to try certain drugs (Step 1) before the plan will cover the prescribed (Step 2) drug. When a prescription for a step therapy drug is submitted “out of order,” meaning you have not first tried the Step 1 drug before submitting a 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. 2024 UMP Select (PEBB) Certificate of Coverage 103