To find out how much your drug will cost, you can use the Prescription Price Check Tool, or call 1-888-361-1611.
ALERT! If you use a non-network pharmacy of any type, you will pay the entire cost of the drug upfront and must submit a claim. However, only the allowed amount for covered drugs will count toward your deductible or out-of-pocket limit.
Washington State Rx Services has a large network of retail pharmacies, which includes many independent and regional pharmacies in Washington State as well as national chains. Search for a network pharmacy by using the online pharmacy locator or call 1-888-361-1611.
When you get your prescriptions at a network pharmacy, the pharmacy sends the claim to the plan for you, and you pay only what you owe. Before meeting your deductible, this will be the allowed amount for a covered drug. After you have met your deductible, you will pay 15% of a covered drug's allowed amount.
Many network retail pharmacies have vaccinating pharmacists able to administer preventive immunizations at no cost to you. Find a network vaccination pharmacy by using the online pharmacy locator
or call 1-888-361-1611. NOTE:
You will pay the entire cost for any drug not covered by the plan, which will not apply toward either your deductible or your out-of-pocket limit.
TIP: If you take an ongoing prescription drug and purchase between an 84- and 90-day supply, you may be able to save money by using a Choice90 network pharmacy or PPS mail-order pharmacy. Search for a network pharmacy by using the online pharmacy locator to find a Choice90 network pharmacy and compare prices.
ALERT! PPS cannot ship outside of the United States. See "Travel Overrides for Prescription Drugs" if you will be traveling.
Postal Prescription Services (PPS): 1-800-552-6694
(Monday-Friday 6 a.m. to 6 p.m. Pacific Time, Saturday 10 a.m. to 2 p.m.).
Washington State Rx Services 1-888-361-1611 (Monday-Friday 7:30 a.m. to 5:30 p.m.)
If you use a specialty drug
(says “SP” under Specialty drug column of the UMP Preferred Drug List
), the plan covers it only when you use the network specialty pharmacy, Ardon Health
Postal Prescription Services (PPS) is the plan's network mail-order pharmacy. You may call PPS or Washington State Rx Services for more information about mail order.
Steps to get started:
1. Set up an account with PPS by going to www.ppsrx.com or calling PPS at the phone number listed above.
2. Mail your prescription to PPS. Your provider can also electronically send or fax your prescription to PPS at 1-800-723-9023. Prescriptions faxed to PPS must:
- Be faxed from the provider’s office fax machine.
- Be on the provider’s letterhead.
- Include the patient’s name, address, phone number, plan ID number, and date of birth.
NOTE: Only a provider can fax in a prescription. Not following these instructions may cause a delay in filling your prescription.
Refills can be ordered through your online pharmacy account*, or by calling PPS directly.
Prescriptions are usually delivered within 7 to 10 days after the pharmacy receives your prescription.
When using PPS, the same deductible, coinsurance, preauthorization requirements, and limits on coverage apply as for prescription drugs purchased at a retail network pharmacies.
ALERT! If there is a shortage of a specific drug that PPS cannot control and it doesn't have the quantity you ordered, PPS will contact you to discuss your options for obtaining your prescription(s).
Prescriptions mailed or orders placed in December but not filled until January 1 or after will be subject to the deductible applicable on the date the prescription is processed. Because of increased volume at the end of the year, prescriptions submitted to PPS in December may not be processed during the current benefit year.
ALERT! Some durable medical equipment items are not available through PPS; you will need to get them through a network retail pharmacy or preferred durable medical equipment provider.
Use Network Pharmacies and Show Your ID Card to Get the Plan Discount
The plan pays for prescription drugs based on the allowed amount (Washington State Rx Services' standard reimbursement). If you use a non-network pharmacy or do not show your ID card at a network pharmacy, and the amount charged is more than the allowed amount, you will pay the difference in addition to your coinsurance.
*This is an external site that requires registering for a personal online account.