Tobacco cessation services ALERT! If you get nicotine replacement therapy or prescription drugs for tobacco cessation at a non-network pharmacy, or purchase at a cash register other than the pharmacy counter, and submit a claim, you may not receive full reimbursement from the plan. See the “Where to buy your prescription drugs” section for how to locate a network pharmacy. Prescriptions purchased from an excluded pharmacy will not be covered. See the definition of “Excluded pharmacy”. The services described in this section are covered only for tobacco cessation. Nicotine replacement therapy and prescription drugs for tobacco cessation that are listed as “Preventive” in the Tier column on the UMP Preferred Drug List are not subject to your prescription drug deductible or coinsurance. If you purchase an over-the-counter tobacco cessation product without a valid prescription, the plan will not cover it and you will pay the full cost. TIP: You do not have to enroll in the tobacco cessation program to get coverage of nicotine replacement therapy or prescription drugs for tobacco cessation. See below for limits and rules on accessing these services. Nicotine replacement therapy The plan covers only certain nicotine replacement therapy products (such as gum, patches, sprays, inhalers, tablets, or lozenges) at the preventive rate. Those that are preventive are listed as “Preventive” in the Tier column on the UMP Preferred Drug List. The plan does not normally cover over-the-counter drugs, but the plan covers nicotine replacement products when they are purchased at a network pharmacy using your UMP member ID card. You may get nicotine replacement therapy directly from the tobacco cessation program (see the “Tobacco cessation program” section below), or by following these steps: 1. Get a prescription from your provider. 2. Take the prescription to a network pharmacy. 3. Make your purchase at the pharmacy counter of a network pharmacy. Give your prescription and your UMP member ID card to the pharmacist. The purchase must be submitted through the prescription drug system to be covered. If you do not provide a valid prescription at the pharmacy counter, the plan will not cover it. If you get a nicotine replacement therapy product not designated as preventive, the plan will not cover it, and you will pay the full cost. To request full coverage of non-preventive nicotine replacement therapy for a medical reason, see “How to request an exception” below. The plan does not cover e-cigarettes or vaporizers (“vapes”). Counseling The plan covers in-person counseling related to tobacco cessation at the preventive rate when you see a preferred or participating provider. 74 2024 UMP Select (PEBB) Certificate of Coverage