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Nonprescription drugs and supplies If you are prescribed a noncovered prescription drug not listed on the UMP Preferred Drug List, you may request an exception. For the exception process, refer to “Requesting an exception for noncovered prescription drugs” on page 86. Your prescription drug benefit also includes the following nonprescription drugs and supplies: • FDA-approved over-the-counter contraceptives. For the plan to cover FDA-approved over-the-counter contraceptives, you must present your UMP member ID card and make your purchase at the pharmacy counter. When possible, get a prescription, as not all pharmacies have prescribing authority. If you go to a pharmacy without a prescription and the pharmacy does not have prescribing authority, you will need to submit a claim to WSRxS. • Diabetes care supplies, such as test strips, lancets, insulin syringes, and continuous glucose monitors used in the treatment of diabetes. See the “Diabetes care supplies” benefit for more information. • Other over-the-counter products that are specifically noted in the UMP Preferred Drug List as covered by the plan. • Each month, up to two over-the-counter COVID test kits will be covered as described in the UMP Preferred Drug List Products covered under the preventive care benefit ALERT! For products covered as preventive — even if normally available over-the-counter without a prescription — you must have a prescription and buy it at the pharmacy counter in a network pharmacy to receive 100 percent reimbursement. You may not receive full reimbursement for claims from non-pharmacy register receipts and non-network pharmacies. Prescriptions purchased from an excluded pharmacy will not be covered. See the definition of “Excluded pharmacy.” Some products are covered under the preventive care benefit if they: • Are recommended by the U.S. Preventive Services Task Force and the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention (see the “Preventive care” benefit); and • Conform to coverage guidelines (see the "How UMP decides which prescription drugs are preferred" section). The brands and types of products covered are limited. For a list of covered preventive care products, check the Preferred Drug List, or contact WSRxS Customer Service. You pay $0 if your provider writes you a prescription and you purchase these products from the pharmacy counter at a network pharmacy. If you purchase over-the-counter and send in a paper claim, you may pay part of the cost. Contraceptive drugs and supplies are covered as preventive (see the “Family planning services” benefit for details). See the “Tobacco cessation services” benefit for products covered as preventive for tobacco cessation. Injectable drugs available under the pharmacy benefit Certain injectable drugs may only be available through your pharmacy benefit. You can check the UMP Preferred Drug List to see if an injectable drug is covered through your pharmacy benefit. Some injectable drugs may need to be administered by a health care provider, and these drugs are typically available 2024 UMP Plus–UW Medicine ACN (PEBB) Certificate of Coverage 89

UMP Plus–UW Medicine Accountable Care Network (UW Medicine ACN) COC (2024) - Page 90 UMP Plus–UW Medicine Accountable Care Network (UW Medicine ACN) COC (2024) Page 89 Page 91