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 Plus members:
- 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.
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.