Rather, REMS focuses on preventing, monitoring, and/or managing a specific serious risk by informing, educating, and/or reinforcing actions to reduce the frequency and/or severity of the event. If the REMS program is not followed, the plan may not cover the restricted drug. Preauthorizing prescription drugs Preauthorization is a process that helps make sure that prescription drug benefits are administered as designed and that plan members receive a drug therapy that is safe and effective for their conditions, and provides the greatest value. Some prescription drugs require preauthorization to determine whether they are medically necessary and meet all applicable coverage criteria, or the plan will not cover them. You may find out if your prescription drug requires preauthorization by contacting WSRxS Customer Service or checking the UMP Preferred Drug List on the UMP Prescription drug coverage webpage (see the Directory pages at the beginning of this booklet for links and contact information). You and your prescribing provider may also find the coverage criteria for your prescription drug by referring to the Washington State Rx Services (Moda) preauthorization (UMP PEBB Plans) preauthorization requirements on forms and publications at hca.wa.gov/ump-forms-pubs. If your prescription drug requires preauthorization, your pharmacist or prescribing provider may initiate a request through CoverMyMeds, a free online platform that accepts requests from electronic health 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. 2024 UMP Classic (PEBB) Certificate of Coverage 103