To request a travel override, contact WSRxS Customer Service. Refill too soon The plan will not cover a refill until 84 percent of the last prescription should be used up. Claims for therapeutic equivalents of the previously prescribed drug will also be denied. This also applies if your prescription is damaged, destroyed, lost, or stolen. For example, if you get a 90-day supply and you try to refill this prescription before 76 days have passed, coverage will be denied. However, in the event of an emergency or other urgent circumstance, you may request an exception to override the refill too soon policy. The plan may require documentation to support your request. Approval of your request is at the sole discretion of the plan. Early refill for a natural disaster You may request an early refill for your prescription when you need to evacuate for a natural disaster. To request an early refill or to locate pharmacies that remain open near you, contact WSRxS Customer Service. What to do if the plan denies coverage TIP: If your prescription coverage is denied by the pharmacy due to plan enrollment issues, contact: Employees: Your employer’s payroll or benefits office. Retirees, PEBB Continuation Coverage, and retired employees of a former employer group: PEBB Program at 1-800-200-1004 (TRS: 711). If a network pharmacy (including mail-order or specialty drug) tells you that preauthorization is required, coverage is denied, or quantities are limited, you, your pharmacist, or your prescribing provider may contact WSRxS Customer Service to request a coverage review or preauthorization. If WSRxS denies the coverage request, you have the right to submit an appeal (see the “Complaint and appeal procedures” section). If your provider thinks you need the prescription drug immediately, they may request an expedited review by submitting all clinically relevant information to the plan by phone or fax. An expedited appeal replaces the first and second level appeals. WSRxS will decide on coverage of the prescription drug within 72 hours of the request. In this case, you may choose to purchase a three-day supply at your own expense. Prescription drugs and products UMP does not cover Prescription drugs and products not covered under the prescription drug benefit include, but are not limited to, noncovered prescription drugs and excluded drugs and products. Noncovered prescription drugs • Noncovered prescription drugs are not covered without an approved UMP Preferred Drug List exception request For more information, see the “Noncovered prescription drugs” section on page 88. Excluded drugs and products • Dental preparations, such as rinses and pastes. • Dietary/food supplements, vitamins, minerals, herbal supplements, and medical foods. 2024 UMP Classic (PEBB) Certificate of Coverage 107