Quantity limits Certain prescription drugs have a per prescription limit on how much you get for each fill. If you need more than this limit allows, your pharmacist or prescribing provider may initiate a request through CoverMyMeds on the CoverMyMeds website or contact WSRxS Customer Service. See the Directory pages at the beginning of this booklet for links and contact information. If WSRxS denies your request or your provider or pharmacist does not get preauthorization, the plan will cover the prescription drug only up to the quantity limit amount. You will pay for any extra amount. Specialty drugs ALERT! Specialty drugs can be expensive. If you are not able to be home to receive the drug in the mail, it may be a good idea to request that it be sent with a requirement for a signature, or find an alternate point of delivery to ensure the package is not stolen. Specialty drugs are high-cost injectable, infused, oral, or inhaled prescription drugs or products that require special handling and storage and are subject to additional rules. You may find out if a drug is a specialty drug 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). Specialty drugs are covered under the cost-share tier listed on the UMP Preferred Drug List. Specialty drugs are covered only when purchased through the plan’s network specialty drug pharmacy. If that pharmacy does not have access to a specialty drug, you will be notified to fill your prescription at another specialty drug pharmacy. If the network specialty drug pharmacy gains access to the specialty drug, you will receive notification to transfer your prescription to that pharmacy. You may receive up to a 30-day supply for most specialty prescription drugs per prescription or refill. However, some may be limited to a 15-day supply due to high discontinuation rate, short duration of use, or to make sure that the prescription drug is not causing harmful side effects. Specialty drugs require preauthorization. See “Preauthorizing prescription drugs” on page 103 for how to request preauthorization. A patient care coordinator will work with you to schedule a delivery time for the prescription drug. The specialty drug pharmacy will deliver your prescription drugs anywhere in the U.S. that you choose, such as to your workplace or to a neighbor if you cannot be home for the delivery. Specialty prescription drugs often require special handling and storage. The plan is not responsible for replacement of lost, stolen, expired, or damaged prescription drugs or products (see the “What the plan does not cover” section). If your provider will be administering the prescription drug, you may have it shipped to the provider’s office. However, once the provider’s office receives the prescription drug, the provider takes responsibility for it. The plan’s network specialty drug pharmacy cannot ship outside the U.S. See “Travel overrides for prescription drugs” on page 106 if you will be traveling. Prescription cost-limit for specialty drugs ALERT! The prescription cost-limit is the most you will pay for an individual prescription. However, you may pay less based on normal coinsurance (see the "What you pay for prescription drugs" section). 104 2024 UMP Classic (PEBB) Certificate of Coverage