ALERT! Diplomat, the plan's network specialty pharmacy, is unable to ship outside the United States. See travel overrides for prescription drugs if you will be traveling outside the country.
"Specialty" drugs are high-cost injectable, infused, oral, or inhaled drugs that generally require special handling (including a few products, such as intrauterine devices [IUDs]). Specialty drugs are subject to special rules. You can find out if a drug is a specialty drug by checking the UMP Preferred Drug List, or by calling Washington State Rx Services. Specialty drugs are covered under the cost-share tier listed on the UMP Preferred Drug List. If your Tier 3 specialty drug has a generic equivalent, you will also have to pay the ancillary charge*, which means you may pay more than the $150 cost-limit shown in the table.
You may receive up to a 30-day supply for specialty medications per prescription or refill. Specialty drugs are covered only when purchased through the plan's network specialty drug pharmacy. Order your specialty medications from Diplomat Specialty Pharmacy at 1-877-203-8602 (hours are Monday-Friday 5 am to 8 pm Pacific Time, and Saturday 6 am to 2 pm).
Specialty drugs require preauthorization. A Patient Care Coordinator will contact your provider to review the coverage criteria and authorize the prescription if the criteria are met. The Patient Care Coordinator will work with you to schedule a delivery time for the medication. If you are unable to be present for the delivery, the specialty pharmacy will deliver your medications anywhere you choose, such as to your workplace or to a neighbor, but not out of the country. Specialty medications often require special handling and storage, so someone must be present to sign for them.
If your provider will be administering a medication, you can have it shipped to the provider's office. However, once the drug is received at the provider's office, the provider takes responsibility for the drug.
*The ancillary charge no longer applies effective January 1, 2014. After that date, you’ll pay the
normal coinsurance for nonpreferred brand-name drugs that have a generic equivalent.