Contraceptives ALERT! Visits for placement and removal of covered contraceptive devices that require professional insertion and removal are covered at the preventive rate. Contraceptives are covered under the prescription drug benefit. Contraceptives include, but are not limited to, birth control pills, emergency contraception (the “morning after” pill), vaginal rings, patches, implants, injectables, condoms, and spermicides. Final determination of medical necessity for FDA approved contraceptives is determined by the prescribing provider. Quantity limits still apply. You may purchase up to a 12-month supply of contraceptives. Contact Washington State Rx Services (WSRxS) Customer Service for information on how to obtain a 12-month supply. The replacement of lost, expired, or stolen contraceptives is not covered. You may obtain emergency contraception over-the-counter without a prescription. When possible, it is best to obtain a prescription, since not all pharmacies have prescribing authority. If you go to a pharmacy without a prescription and the pharmacy does not have prescribing authority, you will need to submit a claim to WSRxS. Members will need to contact the pharmacy directly for information on prescribing authority. Barrier devices All barrier devices requiring a prescription, fitting, insertion (includes IUD placement immediately after delivery), or removal are paid at the preventive rate when you see a preferred or participating provider or use a network pharmacy. Barrier devices requiring a prescription or fitting include intrauterine devices (IUDs), diaphragms, and cervical caps. Over-the-counter contraceptives Over-the-counter contraceptives are covered under the Preventive Tier (P) on the UMP Preferred Drug List (see “The UMP Preferred Drug List” section for more information), only if they are approved by and registered with the FDA. For the plan to cover FDA-registered over-the-counter contraceptives, you must present your UMP member ID card and make your purchase at the pharmacy counter. When possible, it is best to obtain a prescription, since not all pharmacies have prescribing authority. If you go to a pharmacy without a prescription and the pharmacy does not have prescribing authority, you will need to submit a claim to WSRxS. Sterilization When you see a preferred or participating provider, sterilization procedures, such as tubal ligation or vasectomy, are paid at the preventive rate and are not subject to your medical deductible. Services and products not covered under the family planning benefit The plan does not cover the following services and products as a family planning benefit: • Over-the-counter products not approved by and registered with the FDA • Reversal of voluntary sterilization • Treatment of fertility or infertility, including direct complications resulting from such treatment 2024 UMP Classic (PEBB) Certificate of Coverage 51