and failed to produce a therapeutic response. If the requested exception is for a brand-name prescription drug that has an FDA-approved generic equivalent, your prescribing provider must document your inadequate response to at least two manufacturers of the generic drug, or to all manufacturers of the generic drug if there are fewer than two manufacturers, in addition to all other preferred therapeutic alternatives before an exception is granted; or ▪ Confirmation and documentation from your prescribing provider that all preferred therapeutic alternatives (Value Tier, Tier 1, and Tier 2), including the required number of manufacturers of the same generic prescription drug, caused an adverse drug reaction that prevents you from taking the prescription drug as directed. If the requested exception is for a brand-name prescription drug that has an FDA-approved generic equivalent, your prescribing provider must document your adverse drug reaction to at least two manufacturers of the generic drug, or to all manufacturers of the generic drug if there are fewer than two manufacturers, in addition to all other preferred therapeutic alternatives, before an exception is granted. ▪ If the plan determines the information submitted confirms you have tried all the alternative drugs and none are found to be effective, or if the alternatives are found to not be medically appropriate, then your exception request may be approved. When the plan approves an exception, you will pay the Tier 2 cost-share (see “what you pay for prescription drugs”). If your exception request is denied, the plans response letter will include the reason for the denial and the steps you can take next. ALERT! The exception process for noncovered drugs cannot be used for drugs that UMP excludes. For more information about drugs UMP excludes, see the “Prescription drugs and products UMP does not cover” and the “What the plan does not cover” sections. How UMP decides which prescription drugs are preferred Washington State P&T Committee and WSRxS P&T Committee provide recommendations to HCA. WSRxS and HCA review the recommendations and determine which medications are included on the UMP Preferred Drug List, as well as the tier level. The UMP Preferred Drug List includes the committees’ coverage recommendations. Not all prescription drug classes are reviewed by the Washington State P&T Committee. For these prescription drugs, the WSRxS P&T Committee makes coverage recommendations for HCA’s review and final determination of a drug’s tier level. For the plan to cover a prescription drug for you, it must be medically necessary for your health condition. Your provider may prescribe a drug or drug dosage that does not meet the plan’s definition of medically necessary and therefore will not be covered. ALERT! A prescription drug may be noncovered even if no generic equivalent is available. Guidelines for prescription drugs UMP covers To be covered, a prescription drug must meet all of the following: • Is listed on the UMP Preferred Drug List (The Preferred Drug List is subject to change). • Does not have a nonprescription alternative, including an over-the-counter alternative with similar safety, effectiveness, and ingredients. 88 2024 UMP Select (PEBB) Certificate of Coverage