Uniform Medical Plan (UMP) Classic prescription drug benefit are listed in this booklet, along with how they’re covered. 32452 0 obj <> endobj Regence BlueShield is an Independent Licensee of the Blue Cross and Blue Shield Association Alert: All specialty drugs require preauthorization. A formulary is a list of covered drugs selected by our plan in consultation with a team of health care providers, which represents the prescription therapies believed to be a necessary part of a quality treatment program. A formulary is a list of covered drugs selected by our plan in consultation with a team of health care providers, which represents the prescription therapies believed to be a necessary part of a quality treatment program. Our plan will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is Your plan covers drugs listed on the Regence BlueShield Essential Formulary. Download our mobile app. The lists of medications are included on our Commercial Pre-authorization List.. Review estimated copay . This site is meant to help you learn about our health plans and other benefits and services. Search drug details. 360-352-8262 The table below does not include every limit or exclusion under this benefit. Pre-authorization for certain specialty medications is required for CHG Healthcare Services (group #70000004), IEC Group (group #70000000) and Alsco Inc. (group #70000002) members. 2020 Changes to UMP Prescription Drug Formulary. Regence MedAdvantage + Rx Classic (PPO) H3817-008 is a 2021 Medicare Advantage Plan or Medicare Part-C plan by Regence BlueCross BlueShield of Oregon available to residents in Oregon and Washington. Pharmacy benefits. This document is available electronically and may be available in alternate formats. The information on … 1-800-562-6097 (toll free) regence.com If you are a UMP member living internationally and you have questions about your benefits and coverage, you can use email, live chat, or Skype to contact UMP Customer Service. The purpose of the resolution is to try to control drug costs. Our mission is to unite retired public employees for their mutual benefit and welfare. The formulary is a list of prescription generic, brand name and … If you see an out-of-network or participating provider, you will pay 40 percent coinsurance for covered services after you meet your medical deductible. • Eligibility complaints or appeals. Cancel Proceed. • Adding or removing dependents. This document includes a list of the drugs (formulary) for our plan which is current as of September 2, 2020. Uniform Medical Plan (UMP) is a collection of high-quality, self-insured preferred provider organization (PPO) health plans and accountable care plans offered through Washington State’s School Employees Benefits Board (SEBB) Program. • Premium surcharge questions. 1. Olympia, WA 98501. If you have other pharmacy insurance coverage, please contact WSRxS to provide the information we need to ensure your claims are paid accurately. © Copyright 2021 - Retired Public Employees Council of Washington. • Finding forms. If a UMP member is prescribed a drug that is not on the formulary, the member will need to pay the full cost of the drug. For more details, refer to your plan’s . You must generally use network pharmacies to use your prescription drug benefit. For additional information about your prescription Regence Provider Appeal Form Use the appeal form to disagree with our decision that: ... An enrollee is discharged from a facility and insufficienttime exists for institutional or home health care services to receive approval prior to delivery of the service. Preauthorization requirements are only valid for the month published. by Carol Dotlich, RPEC Executive Board Member. This plan includes additional Medicare prescription drug (Part-D) coverage. Regence BlueShield prescription drug program . Uniform Medical Plan Classic (Medicare) Coverage Period: 01/01/2017 - 12/31/2017 Summary of Benefits and Coverage: What This Plan Covers & What it Costs Coverage for: Individual/Family Plan Type: PPO *Plus any amount exceeding the allowed amount Questions: Call 1-888-849-3681 (TTY 711) for medical. Insurance pays the remaining percentage of the cost. UMP is administered by Regence BlueShield and Washington State Rx Services. See the 2020 Preferred Drug List. Head-to-toe coverage and low-cost virtual care. Extra assistance programs. Page 1 of 8 *For more information about limitations and exceptions, see the plan’s certificate of coverage at hca.wa.gov/ump-sebb-coc. A plan’s network consists of doctors, clinics, hospitals, specialists, and other health care providers. UMP Plus–Puget Sound High Value Network Online: UMP Plus–Puget Sound High Value Network for school employees Phone: 1-877-345-8760 condition and/or would cause you to have adverse medical effects. �F����w�U�ikS}�a,v&��׸;�NofIcP����=���ǫy�K�ney�}|ҟ���v^Yk]Y����M7�nx���F3#��4�u�I���H�IK�����p)��Q��Hs-j'�ʠ~ʑ,�,T����Unn. Preauthorization requirements are only valid for the month published. With a Regence Medigap plan you get: *These programs are not … You are about to leave regence.com and enter another website that is not affiliated with or licensed by the Blue Cross Blue Shield Association. endstream endobj startxref Some drugs may show that they are "not covered." Virtual care. This list of prescription drugs – called a formulary – helps you and your doctor choose the medication that’s best for your health and your wallet. To browse each plan’s network or to find a s… h�bbd``b`�� �ĵ ��@��HLHp� ��@�x�da`b���#���x�x���U Y�� The formulary is a list of prescription generic, brand-name and specialty drugs that have been approved by the FDA. Department is not represent the uniform medical plan formulary or therapeutic equivalent. A formulary is a list of covered drugs selected by our plan co innsultation with a team of health care providers, which represents the prescription therapies believed to be a necessary part of a quality treatment program. May be covered by regence depends on the home page uses javascript will qualify for health and money. Attn: Clinical Review Department ... ☐ I need a drug that is not on the plan’s list of covered drugs (formulary exception). This document includes a list of the drugs (formulary) for our plan which is current as of . 2021 Regence Valiance (PPO) H3817-010 By Regence BlueCross . Our plan will generally cover the drugs listed in our formulary … If so, the only difference between the UMP Plus and UMP Classic prescription drug coverage WSRxS’ clinical team will review the submitted information to determine if the formulary alternatives the member used were ineffective or are not clinically appropriate. Uniform Medical Plan Pre-authorization List The Uniform Medical Plan (UMP) Pre-authorization List includes services and supplies that • Claims. It is a resource to keep you up-to-date about your pharmacy benefit and help you manage your health by providing access to comprehensive health and wellness information. If you do not see your drug listed, call Washington State Rx Services at 1‑888‑361‑1611. Browse lower-cost drug options. Our plan will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at a plan network pharmacy, and other plan rules are followed. Pharmacy benefits. Your email address will not be published. The information on this site is not intended to replace the diagnosis and treatment recommendations of your physician or other health care professionals. Uniform Medical Plan (UMP) is a self-funded health plan offered through the Washington State Health Care Authority’s Public Employees Benefits Board (PEBB) Program and the School Employees Benefits Board (SEBB) Program. You should contact us to ask us for an initial coverage decision for a formulary, tiering or utilization restriction exception. * ... explain medical reason] ☐ Request for formulary tier exception [Specify below: (1) Formulary or preferred drugs contraindicated If the exception is not approved, the member will be directed toward the appropriate alternatives on the formulary, or the member may pay the full cost for the non-formulary drug. Get the facts and know your options. Submit pre-authorizations for these specialty medications to VIVIO Health Help Desk at 1 (925) 365-6600. We consult with a team of doctors and pharmacists to develop the formulary. Dental plans in Alaska provided by Delta Dental of Alaska. Regence BlueShield prescription drug program . These criteria do not imply or guarantee approval. The Classic and CDHP plans share the same large network that includes providers both nationwide and worldwide. h��R_H�Q?�w~}w�7�H�J+f9�(J����� A��e��� � c[,?���&DQZ�f�"$RI�t�=��?롇��AE-�X�CO���������s�9D��JL�';���@�4ːF�K�f;�wlOZ˕2H,����+�6�p To learn more, please call Washington State Rx Services at 888-361-1611. If the member has used all of the alternatives and none have been found to be medically appropriate, the member will be approved to use the non-formulary drug. Uniform Medical Plan WASHINGTON STATE PRESCRIPTION SERVICES . by Carol Dotlich, RPEC Executive Board Member. RPEC members who may be impacted by these changes should talk to their providers and begin the process of either switching medications or beginning the exception process prior to the end of the year to avoid complications in when the policy takes effect on January 1, 2020. 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