UMP Classic, UMP Plus, And UMP CDHP Prescription Drug

What you need to know about the prescription drugbenefit for UMP Classic, UMP Plus, and UMP CDHPWHO IS ELIGIBLE TO ENROLL INTHE UMP PLUS PLANS?UMP Plus is available to PEBB benefits-eligiblemembers who are one of the following: Active employees and their covered dependents. Continuation Coverage members and theirdependents. Active employees and their covered spouses whoare enrolled in Medicare Part A and Part B.* Retirees and their covered dependents notenrolled in Medicare Part A or Part B. COBRA members and their covered dependentsnot enrolled in Medicare Part A or Part B.Members must live in Grays Harbor, King, Kitsap,Pierce, Snohomish, Spokane, Thurston, or Yakimacounties to be eligible to enroll in UMP Plus — PugetSound High Value Network.Members must live in Grays Harbor, King, Kitsap,Pierce, Skagit, Snohomish, or Thurston countiesto be eligible to enroll in UMP Plus — UW MedicineAccountable Care Network.*Due to federal Medicare regulations, employees’ state-registered domesticpartners who are enrolled in Medicare are not eligible for UMP Plus.CONTACT US WITH ANY QUESTIONS.All times are listed as Pacific.Washington State Rx Services(prescription drug benefits)Postal Prescription Services(mail-order pharmacy)Ardon Health(specialty pharmacy)1-888-361-1611 (TRS: 711)www.hca.wa.gov/ump/find-drugs24 hours a day, 7 days a week1-800-552-6694www.ppsrx.comMonday–Friday: 6 a.m.–6 p.m.Saturday: 9 a.m.–2 ay: 8 a.m.–7 p.m.Saturday: 8 a.m.– noonwww.hca.wa.gov/ump

What you’ll pay for covered prescription drugsYou pay your coinsurance for all covered prescription drugs, which is a percentage of the drug’s cost. Youmay get up to a 90-day supply for most drugs, except for specialty drugs. Specialty drugs are limited to a30-day supply and must be purchased through the plan’s network specialty pharmacy, Ardon Health.Prescription DeductibleAnnual out-of-pocket limitsUMP CLASSICUMP PLUSUMP CDHP 100 individual 300 maximum for family of three ormoreSeparate deductible formedical services 0Separate deductible formedical services 1,400 single subscriber 2,800 family accountCombined medical andprescription drugs deductible 2,000 per person,no family max;separate out-of-pocket limits formedical services 2,000 per person,no family max;separate out-of-pocket limits formedical services 4,200 single subscriber 8,400 family max forfamily account/ 6,850 for single memberCombined medical and prescriptiondrugsout-of-pocket limitTierAll networkpharmacies(retail and mailorder)Prescriptioncost-limit per30-day supply(networkpharmaciesonly)All networkpharmacies(retail and mailorder)Prescriptioncost-limit per30-day supply(networkpharmaciesonly)All network pharmacies(retail and mail-order)Preventive0% coinsuranceNo deductible 00% coinsuranceNo deductible0%0% coinsuranceNo deductibleValue Tier5% coinsuranceNo deductible 105% coinsuranceNo deductible 10Tier 1Select generic drugs10% coinsuranceNo deductible 2510% coinsuranceNo deductible 25Tier 2Preferred drugs30% coinsuranceDeductibleapplies 7530% coinsuranceNo deductible 75Tier 3Nonpreferred drugs50% coinsuranceDeductibleappliesSpecialty drugsonly: 15050% coinsuranceNo deductibleSpecialty drugsonly: 150No limit fornon-specialtydrugsNo limit fornon-specialtydrugs15% coinsuranceDeductible applies

UMP Classic and UMP Plus: Value Tier drugsThe Value Tier drugs listed in the table below treat chronic conditions such as diabetes, high cholesterol,high blood pressure and depression. UMP Classic and UMP Plus members pay 5 percent coinsurance forValue Tier drugs at network pharmacies. The list is subject to change as new drugs become available.Health issueHeart,cholesterol,high bloodpressureType of drugAce-inhibitorsAngiotension receptorantagonistTier 3 brand equivalentHealth issueType of drugEnalapril1Vasotec DiabetesLisinopril1Zestril Glucose productioninhibitorsLosartan potassium1Cozaar Metoprolol SuccinateToprol XL AtenololTenormin 11CarvedilolDiureticsCoreg 1Amlodipine1Norvasc Hydrochlorothiazide1Microzide , Ezide Chlorthalidone1Thalitone Furosemide1Lasix Spironolactone1Aldactone Losartan/HCTZ1Lisinopril/HCTZCholesterol lowering agents1Generic drug2Brand name drugSimvastatinLovastatin11Ziac 1Propranolol/HCTZEnalapril/HCTZShort-acting insulinsHyzaar 1Bisoprolol/HCTZCombination hypertensiveInsulin release stimulantsLopressor Metoprolol TartrateCalcium channel blockersNote: UMP CDHP members pay 15 percent coinsurance for all drugs not considered preventive at network pharmaciesafter meeting their deductible, including the drugs listed below.Value Tier drug1Beta-blockersFor the most up-to-date information call Washington State Rx Services or visitwww.hca.wa.gov/ump/find-drugs and select “Ump Drug List: Value Tier Drugs” at the bottom of the page.11Long acting insulinsInderide Value Tier drugTier 3 brand equivalentMetformin1Glucophage Metformin ER 1Glucophage XR Glimepiride1Amaryl Glipizide1Glucotrol Glipizide ER 1Glucotrol XL Glyburide1DiaBeta Novolog Mix 70-30Flex Pen 2N/ANovolog Mix 70-30 2N/ANovolog Flexpen 2N/ANovolog 2N/ANovolin R 2N/ANovolin N 2N/ANovolin 70-30 2N/ALantus 2N/ALantus Solostar 2N/ACombination anti-diabetics Glyburide/Metformin1Vaseretic DepressionZestoretic Zocor Mevacor 1Generic drug2Glucovance Selective serotoninReuptake inhibitors(SSRIs)Citalopram1Celexa Fluoxetine1Prozac Sertraline1Zoloft Tricyclic antidepressantsAmitriptyline1Elavil Brand name drug

Frequently asked questions:1. How can I find a network pharmacy?Visit www.hca.wa.gov/ump/find-drugs or callWashington State Rx Services to find networkpharmacies. Pharmacies are contractedthrough a different network than medicalproviders. If you use a non-network pharmacy,you will pay more and have to submit yourown claims.2. How can I save money onmedications that I take regularly?There are two ways you may be able tosave money.Postal Prescription Services (PPS) mailorder pharmacy: You can save on select brandname drugs when you order from PPS, UMP’smail-order pharmacy. Typically, you willreceive your mail-order prescriptions withinseven to 10 days.Choice90Rx network pharmacy: If youpurchase between an 84-day supply to a90-day supply, you may be able to save moneyby going to a Choice90Rx network pharmacy.Some Choice90Rx network pharmacies areBartell, Costco, CVS Pharmacy at Target,Fred Meyer, Haggen, Safeway and Savon. Tocompare drug prices and see a complete listingof Choice90Rx network pharmacies, visitwww.hca.wa.gov/ump/find-drugs or callWashington State Rx Services.Pharmacy network: national pharmacy chains3. How can I find out how much mydrug costs?Use the prescription price check tool atwww.hca.wa.gov/ump/find-drugs or callWashington State Rx Services.4. What is changing for 2018?There are no changes to the deductible,coinsurance, annual out-of-pocket limits orcost-limit per 30-day supply. To view a list ofanticipated changes to the UMP PreferredDrug List visit www.hca.wa.gov/ump, select“Forms & publications” in the blue bar at thetop of the page, and type “UMP: preferred druglist” into the search box or call WashingtonState Rx Services. The list is updated monthlyand does not contain every anticipated changeto the UMP Preferred Drug List. It onlycontains changes that may negatively impactmembers, such as increasing a drug’s cost orlimiting the amount of medication availableper refill.5. If my drug is not covered bythe Uniform Medical Plan, are theirprograms that offer discounts?Use the Washington Prescription Drug DiscountCard for drugs not covered by your plan. To learnmore about the Washington Prescription DrugProgram visit www.hca.wa.gov/about-hca/prescription-drug-program or call WashingtonState Rx Services.FREE VACCINES AT SELECT PHARMACIES!If you use a network vaccination pharmacy, you can get many immunizations at no cost to you! Thesepharmacies are listed in green on the next page. The plan covers vaccines according to the immunizationschedules set by the Centers for Disease Control (CDC), including flu shots and other commonvaccinations such as whooping cough (pertussis), tetanus, shingles, cervical cancer and meningococcal.Please note UMP does not cover vaccines for travel or employment purposes.Always show the pharmacist your UMP ID card when receiving services.Not all network pharmacies are listed below and the list of network pharmacies is subject tochange. To find UMP network pharmacies or to check the status of a specific pharmacy, visitwww.hca.wa.gov/ump/find-drugs or call Washington State Rx Services. Participating pharmacies inthe chains listed in green can provide vaccines to members age 12 and over.AACME PharmacyAHF PharmacyAlbertson’s, Inc.Assured PharmacyBBartell Drug Co.Bi-Mart CorporationBrookshires PharmacyBroulims PharmacyCCommunity Health CarePharmacyCostco PharmaciesCVS Pharmacy, Inc.HHaggen / TOP PharmacyHannaford Food and DrugHarris Teeter PharmacyHi-School PharmacyHy-Vee PharmacyIIngles PharmacyKKmart PharmacyKroger PharmacyLLewis Family DrugLucky PharmacyDDicks Pharmacy, Inc.Dillon PharmacyDiscount Drug Mart, Inc.Drug EmporiumMMedical Center PharmacyMedicap Pharmacies, Inc.Medicine Shoppe PharmacyMeijer PharmacyEEagle PharmacyExpress PharmacyNNeighborhood PharmacyNucara PharmacyFFamily PharmacyFood City PharmacyFred Meyer PharmacyFred’s PharmacyFranciscan PharmacyOOmnicare, Inc.OSCO PharmacyGGeneva Woods PharmacyGenoa Healthcare Company,LLCGiant Eagle PharmacyGiant PharmacyPPharmaca Integrative PharmacyPharmericaPrice ChopperPublix PharmacyQQFC (Quality Food Centers)QOL MedsRRidley’s PharmacyRite-AidRosauers PharmacySSafeway PharmacySam’s PharmacySavon PharmacyShopkoShoprite PharmacyTThe Medicine ShoppePharmacyThe Drug StoreCVS Pharmacy at TargetUUnited Care PharmacyVValley DrugVillage PharmacyWWalmart Stores, Inc.White Cross PharmacyWinn Dixie PharmacyYYokes PharmacyMail orderPPS (Postal PrescriptionServices)Specialty drugsArdon Health Specialty