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 have to 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 pharmacies in Washington State as well as national chains. To see if your pharmacy is in the network, check 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, plus an ancillary charge for brand-name drugs that have a generic equivalent. This ancillary charge does not apply to your deductible or out-of-pocket limit. 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.
ALERT! PPS cannot ship outside of the United States. See "Travel Overrides for Prescription Drugs" if you will be traveling outside the country.
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.)
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.
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, 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, unless other contractual arrangements or terms apply). 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.