Specialty drugs require preauthorization. See “Preauthorizing prescription drugs” on page 98 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 102 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). See the “How the prescription drug cost-limit works” section for details about the prescription cost-limit. This limit applies to individual prescriptions only. See the “Your prescription drug out-of-pocket limit” section for the annual limit to your prescription drug costs. Specialty drugs are usually limited to no more than a 30-day supply. The prescription cost-limit for a 30-day (or under) supply corresponds to the “You pay” column in the table found in the "How the prescription drug cost-limit works" section. However, some specialty prescription drugs are available only in packages with more than a 30-day supply. In such cases, the prescription cost-limit shown in the table found in the "How the prescription drug cost-limit works" section is calculated by multiplying the standard 30-day prescription cost-limit amount as follows: • A 31- to 60-day supply, multiply the standard prescription cost-limit by two. • A 61-day and greater supply, multiply the standard prescription cost-limit by three. Example: If your specialty drug is Tier 2 and you receive a 45-day supply, the most you will pay (prescription cost-limit) is $150 (standard 30-day limit $75 x 2=$150). Step therapy ALERT! If a Step 1 or Step 2 drug is approved for coverage by WSRxS, you will pay the applicable cost-share of that prescription drug according to its tier in the UMP Preferred Drug List. When a prescription drug is part of the step therapy program, you have to try certain drugs (Step 1) before the plan will cover the prescribed (Step 2) drug. When a prescription for a step therapy drug is submitted “out of order,” meaning you have not first tried the Step 1 drug before submitting a 100 2024 UMP Plus–PSHVN (PEBB) Certificate of Coverage