You may need to submit your own prescription drug claim to UMP for reimbursement if you:

• Purchase drugs at a non-network pharmacy.
• Fail to show your ID card at a network pharmacy.
• Get a prescription from a mail-order or Internet pharmacy other than Wellpartner, the network mail-order pharmacy.
• Have other prescription coverage that pays first and UMP is secondary.

You can download the prescription drug claim form, or call Washington State Rx Services at 1-888-361-1611. Send the completed claim form, along with an invoice from the pharmacy, to:

Washington State Rx Services
Attn: Pharmacy Claims
PO Box 40168
Portland, OR 97240-0168

It’s a good idea to keep copies of all your paperwork for your records.

TIP: You must submit prescription drug claims within 12 months of purchase.

When you submit a prescription drug claim to UMP, we pay the claim based on the following rules, no matter where you purchased the drug:

• Payment is based on the UMP allowed amount. If the billed charge for the drug was more than the UMP allowed amount, you pay the difference (in addition to your coinsurance and deductible).
• UMP pays all non-network prescription drug claims under retail pharmacy coinsurance levels. Non-network Internet or mail-order services are not paid based on mail-order copays.
• If your claim exceeds the quantity limit allowed by UMP or the maximum days’ supply, UMP will pay only for the amount of the drug up to the quantity limit or maximum days’ supply.
• If you request a refill before 84% of the last supply you received should have been taken, UMP will not pay for it. This is called a “refill too soon.”

TIP: Foreign claims for prescription drugs must be translated into English with specific services, charges, drugs and dosage documented, and you must tell us the currency exchange rate. UMP does not pay for this documentation.