Drug Pricing Tiers

How Much Will I Pay?

How much you pay depends on:

See the following table for a summary of how much you'll pay for prescription drugs.

  If you use . . .
If your drug is in . . . A Network Retail Pharmacy (up to a 90-day supply) Wellpartner Mail-Order Pharmacy (up to a 90-day supply)
Tier 1
Generic drugs
10% of the drug's cost $10 1
Tier 2
Preferred brand-name drugs
30% of the drug's cost $50 1
Tier 3
Nonpreferred brand-name drugs and compunded prescriptions
50% of the drug's cost
May be subject to an ancillary charge 2
$100 1
May be subject to an ancillary charge 2
Specialty drugsHigh-cost injectable, infused, oral, or inhaled drugs that require special handling. Available through BioScrip mail-order only. Through BioScrip Mail-Order Pharmacy
Tier 1
Preferred specialty drugs
Not applicable. $10 copay
Limited to a 30-day supply
Tier 3
Nonpreferred specialty drugs
Not applicable. $100 copay
Limited to a 30-day supply
May be suject to an ancillary charge 2

1  For prescriptions purchased through Wellpartner, if the cost of the drug is less than the normal copay, you pay only the cost of the drug.

2  If a Tier 3 drug has a generic equivalent, you pay the Tier 1 cost-share plus the difference in the cost between the brand-name drug and the generic.

What Is the "Ancillary Charge?"

If you get a Tier 3 drug that has a generic equivalent, UMP pays the same amount we would have paid if you had purchased the generic equivalent. You will pay the rest of the drug's cost. In most cases, this is significantly more expensive than the usual cost for a Tier 3 drug. Note: UMP does not make exceptions to this policy.

Prescription Cost-Limit for Tier 1 and Tier 2 Drugs Purchased at a Network Retail Pharmacy

The prescription cost-limit is the most you have to pay out-of-pocket for Tier 1 or Tier 2 drugs purchased at a network retail pharmacy using your UMP ID card. For:

There is no prescription cost-limit for Tier 3 drugs.

Annual Prescription Drug Deductible

There is no deductible for Tier 1 prescription drugs.

You must pay an annual prescription drug deductible to the pharmacy for purchases of Tier 2 and Tier 3 drugs before UMP covers these prescriptions. This deductible is $100 per person (a maximum of $300 for a family of three or more people covered under the same account). The deductible applies regardless of where you purchase your prescription. Once you meet the deductible, UMP pays benefits for the rest of the calendar year.

NOTE: What you pay (copays and coinsurance) for Tier 1 drugs does not count toward your prescription drug deductible.