PPIs are drugs commonly used to treat chronic heartburn or gastroesophageal reflux disease (GERD). Some examples include Prilosec/omeprazole, Prevacid/lansoprazole, and Nexium/esomeprazole.

Drugs classified as PPIs are not covered for adults because PPIs have over-the-counter alternatives available. The plan does not pay for drugs that have an over-the-counter alternative, even if you have a prescription and buy it from a pharmacy. Therefore, if you use a PPI, you pay the entire cost of the drug.

ALERT! PPIs prescribed for persons under age 18 are covered, because the available over-the-counter alternatives are not approved for persons under age 18. Contact Washington State Rx Services at 1-888-361-1611 for more information.

As for all noncovered drugs, what you pay does not count toward the following:

  • UMP Classic: Your prescription drug deductible or prescription drug out-of-pocket limit.
  • UMP CDHP: Your deductible or out-of-pocket limit.
  • UMP Plus: Your prescription drug out-of-pocket limit.
UMP Plus members: Your prescription drug coverage is the same as UMP Classic's, except you do not pay a prescription drug deductible.

For advice on alternative medications, talk to your prescribing provider.