records, or directly through the CoverMyMeds Portal. To get started, your pharmacist or prescribing provider can go to the CoverMyMeds website. They may also contact WSRxS Customer Service to request it. If you have an existing authorization from UMP for a brand-name drug, and a generic drug becomes available, you may need to renew your authorization to continue filling the brand-name drug. However, if you switch to the generic drug, a new preauthorization is not required until the existing authorization expires. Note: Prescription drugs covered under the medical benefit rather than the prescription drug benefit have different rules for preauthorization. Contact UMP Customer Service for details. Emergency fill Emergency fill lets you get a limited quantity of certain prescription drugs while the plan processes your preauthorization request. This option is only available when a delay could result in emergency care, hospital admission, or a serious threat to your health or others in contact with you. Contact WSRxS Customer Service for questions about which prescriptions drugs may qualify for emergency fills. You must bring your prescription to a network pharmacy and state that you need an emergency fill while the plan processes your preauthorization request. You pay your coinsurance under the prescription drug’s tier. The plan will cover an emergency fill of up to a seven-day prescription drug supply. If your preauthorization request is denied, you will pay the full cost of the prescription drug for any quantity you receive after the emergency fill. Emergency fill limits The following limits still apply to emergency fill prescription drugs: • Quantity limits: You cannot get more than the stated quantity limit under an emergency fill. If you have a current filled prescription for a prescription drug (or its therapeutic equivalent) and it was filled to the quantity limit, you cannot get an emergency fill until you have used 84 percent or more of the filled prescription. • Refill too soon: If you have a filled prescription for a prescription drug (or its therapeutic equivalent), you cannot get an emergency fill until you have used 84 percent or more of the filled prescription. Quantity limits Certain prescription drugs have a per prescription limit on how much you get for each fill. If you need more than this limit allows, your pharmacist or prescribing provider may initiate a request through CoverMyMeds on the CoverMyMeds website or contact WSRxS Customer Service. See the Directory pages at the beginning of this booklet for links and contact information. If WSRxS denies your request or your provider or pharmacist does not get preauthorization, the plan will cover the prescription drug only up to the quantity limit amount. You will pay for any extra amount. Specialty drugs ALERT! Specialty 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. 2024 UMP Select (PEBB) Certificate of Coverage 101