drugs to be among the most cost-effective drugs for their therapeutic class or category due to their favorable pricing. Noncovered prescription drugs Noncovered prescription drugs are not covered unless a Preferred Drug List exception is requested and approved (see “Requesting an exception for noncovered prescription drugs”). These prescription drugs have been reviewed by the Washington State Pharmacy and Therapeutics (P&T) Committee or WSRxS. HCA or WSRxS has found these drugs are not as cost-effective and do not have a clinically significant therapeutic advantage over the Preferred Drug List alternative(s). ALERT! When a generic equivalent for a brand-name prescription drug becomes available, the brand-name drug immediately becomes noncovered. An exception must be requested and approved for coverage of the brand-name drug if you want to continue using the brand-name drug. Always ask your provider to allow substitution on your prescriptions to save you money. See the “Substitution under Washington State law” section for information on transitioning from a brand-name to generic prescription drug, Requesting an exception for noncovered prescription drugs ALERT! The UMP Preferred Drug List may not show every alternative prescription drug you must try before an exception may be granted. If your exception request is denied, the plan’s response letter will include the reason for the denial and the steps you can take next. If you are prescribed a noncovered drug, and 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, you or your prescribing provider can request an exception by contacting WSRxS Customer Service. Your prescribing provider can also use CoverMyMeds to request an exception. CoverMyMeds is a free online platform that reviews exception requests from electronic health record systems or directly through the CoverMyMeds portal. To get started, have your provider visit the CoverMyMeds website (see Directory for link). Preferred drug list exceptions and coverage determinations require medical information and are based on medical necessity. Therefore, your prescribing provider must submit clinical information for review and will need to provide WSRxS with the following information: • The prescribing provider’s contact information; • An explanation of why the plan should grant an exception; • An explanation of how the requested medication therapy is evidence-based and generally accepted medical practice; • Documentation of medical necessity for the requested prescription drug over all other preferred therapeutic alternatives (Value Tier, Tier 1, and Tier 2); and • At least one of the following items must also be included with the exception request: ▪ Confirmation and documentation from your prescribing provider that all preferred therapeutic alternatives (Value Tier, Tier 1, and Tier 2) were tried for a clinically appropriate duration of treatment 2024 UMP Select (PEBB) Certificate of Coverage 87