hospital admission, or a serious threat to your health or others in contact with you. Contact WSRxS Customer Service for questions about which prescriptions drugs may qualify for emergency fills. You must bring your prescription to a network pharmacy and state that you need an emergency fill while the plan processes your preauthorization request. You pay your coinsurance under the prescription drug’s tier. The plan will cover an emergency fill of up to a seven-day prescription drug supply. If your preauthorization request is denied, you will pay the full cost of the prescription drug for any quantity you receive after the emergency fill. Emergency fill limits The following limits still apply to emergency fill prescription drugs: • Quantity limits: You cannot get more than the stated quantity limit under an emergency fill. If you have a current filled prescription for a prescription drug (or its therapeutic equivalent) and it was filled to the quantity limit, you cannot get an emergency fill until you have used 84 percent or more of the filled prescription. • Refill too soon: If you have a filled prescription for a prescription drug (or its therapeutic equivalent), you cannot get an emergency fill until you have used 84 percent or more of the filled prescription. 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. 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. 2024 UMP Plus–PSHVN (PEBB) Certificate of Coverage 99