Prescription drug deductible This plan does not have a prescription drug deductible. Your coinsurance for prescription drugs ALERT! See page 59 for special prescription drug coverage while in hospice care. You pay coinsurance for most covered prescription drugs, which is a percentage of the drug’s cost. You may purchase up to a 90-day supply for most prescription drugs. For most specialty drugs, you may purchase up to a 30-day supply. If you have other prescription drug coverage If you have primary medical coverage through another plan that covers prescription drugs, some of the limits and restrictions to prescription drug coverage listed on page 121 will apply when UMP pays secondary to another plan. See the “Submitting a claim for prescription drugs” section for how to submit your prescription drug claim. Using network pharmacies when UMP is secondary If you have primary coverage through another plan that covers prescription drugs, show both plan cards to the pharmacy and make sure they know which plan is primary. It is important that the pharmacy bills the plans in the correct order, or claims may be denied or paid incorrectly. Using mail-order pharmacies when UMP is secondary If your primary plan uses UMP’s network mail-order pharmacies, these pharmacies may process payments for both plans and charge you only what is left. Make sure that UMP’s network mail-order pharmacies have your information for both plans and know which plan is primary. However, if your primary plan uses a different mail-order pharmacy, you will have to use your primary plan’s mail-order pharmacy, then submit a paper claim for payment by UMP. See the “Submitting a claim for prescription drugs” section for how to do this. How the prescription drug cost-limit works ALERT! For annual limits to your prescription drug costs, see the “Your prescription drug out- of-pocket limit” section. The prescription drug cost-limit is the maximum you pay for an individual prescription at a network pharmacy. The prescription cost-limit applies at all network pharmacies. Value tier cost-limit Tier 1 cost-limit Tier 2 cost-limit, except for • 0-30-day supply: $10 • 0–30-day supply: $25 covered insulins. See the • 31–60-day supply: $20 • 31–60-day supply: $50 UMP Preferred Drug List • 61–90-day supply: $75 for cost limits • 61–90-day supply: $30 • 0–30-day supply: $75 • 31–60-day supply: $150 • 61–90-day supply: $225 92 2024 UMP Plus–PSHVN (PEBB) Certificate of Coverage