Guidelines for Drugs Covered

To be covered by UMP, a prescription drug must meet all of the following criteria:

• Can be legally obtained only with a written prescription.
• Does not have an over-the-counter equivalent. (See exceptions below.)
• Is not classified as a vitamin (except as listed below), mineral, dietary supplement, or medical food.
• Is approved by the Food and Drug Administration (FDA).

UMP covers the following prescription drugs as exceptions to the above rules:

• Fluoride supplements for prevention of dental caries for children ages 6 months to 18 years.
• Prescription prenatal vitamins (only during pregnancy).
• Vitamin D for patients on renal dialysis.

Your UMP pharmacy benefit also includes the following supplies and nonprescription drugs:

• All insulin and diabetic supplies such as blood glucose meters, test strips, lancets, and insulin syringes used in the treatment of diabetes (see “How does UMP cover insulin and diabetes care supplies?” for more information).
• Contraceptive devices and drugs (see Family Planning benefit).
• Over-the-counter prenatal vitamins (during pregnancy).
• Other over-the-counter products and prescription drugs with over-the-counter equivalents that are specifically noted in the UMP Preferred Drug List (UMP PDL) as covered under Tier 1, Tier 2, or Tier 3.

To be covered, the above-listed prescription and non-prescription drugs and supplies must be prescribed by an approved provider type, and must be medically necessary. Drugs and supplies must be dispensed from a licensed pharmacy employing licensed registered pharmacists.

UMP covers FDA-approved drugs used for off-label indications (that is, prescribed for a use other than its FDA-approved label) only if recognized as effective for treatment:

• In a standard reference compendium (see definition).
• In most relevant peer-reviewed medical literature (see definition), if not recognized in a standard reference compendium.
• By the federal Secretary of Health and Human Services.

UMP will not cover any drug when the FDA has determined its use to be unsafe.