Formularies
UCare for Seniors Medicare Advantage: Individual Part D Plans [Care Type = Value Plus or Classic on the member ID card]› 2010 Part D Formulary: Value Plus and Classic
UCare for Seniors Medicare Advantage: Group Part D Plans [Care Type = Group on the member ID card] › 2010 Four-Tier Formulary› 2010 Two-Tier Formulary› 2010 Formulary Addendum (for Group only)
UCare Special Needs Plans (SNPs): MSHO and UCare Connect› 2010 SNP Comprehensive Formulary
Prior Authorization Form
Prior authorization requests should be telephoned to ESI by calling 1-877-558-7521 or filling out the form below and faxing it to them at 1-800-357-9577.
› Part D Prior Authorization Form
Member Reimbursement Claim Form for Part D Drugs
› Part D Member Claim Form for UCare for Seniors
› Part D Member Claim Form for SNPs