When a brand-name or biologic prescription drug has a generic equivalent or interchangeable biosimilar, pharmacists in Washington State must substitute the generic equivalent or interchangeable biosimilar drug for the brand-name or biologic prescription drug. When a generic equivalent for a brand-name prescription drug becomes available, the brand-name drug immediately becomes noncovered. Your provider may write the prescription “dispense as written” if they want you to get only the prescribed brand-name or biologic prescription drug. Or you may tell the pharmacist you want the brand-name or biologic drug. Regardless of whether you or your prescribing provider ask the pharmacist to “dispense as written,” if you get the noncovered prescription drug, the plan may not cover it. Final determination of medical necessity for FDA-approved contraceptives is determined by the attending prescribing provider. To request an exception for a noncovered drug, see page 90. Therapeutic Interchange Program The Washington State Therapeutic Interchange Program allows a pharmacist to substitute a “therapeutic alternative” drug for a noncovered drug in certain cases. Therapeutic alternatives are drugs that are chemically different from your prescribed drug but provide the same therapeutic benefit. You may find out if your prescription drug is affected by the Therapeutic Interchange Program by checking the UMP Preferred Drug List on the UMP Prescription drug coverage webpage or by contacting WSRxS Customer Service (see Directory for link and contact information). The Therapeutic Interchange program does not affect all noncovered prescription drugs. The pharmacist will substitute the preferred drug when your prescribing provider has “endorsed” the Washington Preferred Drug List, and: • You are filling your prescription in Washington State or through UMP’s network mail-order pharmacies. • Your prescribing provider allows substitution on your prescription. If you do not want your prescription drug to be changed, the plan may not cover your drug if you ask the pharmacist to fill the prescription as written. Regardless of whether you or your prescribing provider ask the pharmacist to “dispense as written,” if you get the noncovered prescription drug, the plan may not cover it. The pharmacy will contact your provider to request authorization for the substitution. If approved by the provider, you will receive the alternative preferred drug along with a letter of explanation. If the pharmacy cannot get an authorization from your provider within 48 hours, the prescription will be filled as written, and you will be charged the full price of the drug. Travel overrides for prescription drugs You may request a travel override to get an extra supply of prescription drugs for extended travel. All of the conditions listed below apply. • You may request a travel override up to two weeks before your departure. • You may request no more than two travel overrides per calendar year, including all travel within or outside the U.S. • Within the U.S., you may request up to a 90-day supply per prescription, or as allowed under that prescription. • Outside the U.S., you may request up to a six-month supply per prescription, or as allowed under that prescription. • Travel overrides will be granted only while you are covered by the plan. If your eligibility is ending, the plan does not cover prescription drugs past the time your enrollment in the plan ends. • You will pay applicable charges (deductible and coinsurance) for each extra supply received. 106 2024 UMP Classic (PEBB) Certificate of Coverage