Prescription Drug Coverage

Your co-pays for the first $2,700 of your annual prescription drug costs are as follows (and UCare pays the rest):

• Up to an $5 co-pay per generic drug up to a 30-day supply.


• $30 co-pay per preferred brand-name drug up to a 30-day supply.


• $60 co-pay per other brand-name drug up to a 30-day supply.


• 25% co-insurance per specialty drug up to a 30-day supply.


• Two co-pays for a 90-day supply of maintenance drugs through our mail order program and at network retail pharmacies that offer a 90-day supply.

Once you have reached $2,701 in annual prescription drug costs, you pay the following for generic drugs:

• Up to an $5 co-pay per generic drug up to a 30-day supply.


• Two co-pays for a 90-day supply of maintenance drugs through our mail order program and at network retail pharmacies that offer a 90-day supply.

During this time you pay 100% of the cost of brand-name drugs until you have paid $4,350 in out-of-pocket prescription drug costs.^*