Medicare Advantage and Special Needs Plans

Formularies

UCare for Seniors and UCare Secure Medicare Advantage: Individual Part D Plans [Care Type = Value Plus, Classic, or UCare Secure on the member ID card]

› 2009 Part D Formulary: Value Plus, Classic, UCare Secure
› Formulary Changes

UCare for Seniors Medicare Advantage: Group Part D Plans [Care Type = Group on the member ID card]

›    2009 Part D Formulary: 4 Tier Open - Group
›    Formulary Changes: 4 Tier
›    2009 Part D Formulary: 2 Tier Open - Group
›    2009 Formulary Supplement - Group (additional coverage)

UCare Special Needs Plans (SNPs): Senior Health Options (MSHO), UCare Complete Disability Health Options (MnDHO), and UCare Connect

›    2009 SNP Comprehensive Formulary
›    Formulary Changes
›    Formulary Supplement_SNP (additional coverage)

Medicare Part D Prior Authorization/Exception Requests

Prior authorization requests may be faxed directly to RxAmerica using the forms below. Part D drugs that require prior authorization are so indicated on each formulary list.

› UCare Prior Authorization Criteria for Medicare Part D

Part D Prior Authorization Forms from RxAmerica (For Medicare Part D Only)

›  Actiq^® (fentanyl)
›  Avonex® and Rebif® (interferon beta - 1a)
›  Banzel® (rufinamide)
›  Betaseron® (interferon beta - 1b)
›  Byetta® (exenatide)
›  Copaxone® (glatiramer)
›  Enbrel® (etanercept)
›  Forteo® (teriparatide)
›  Humira® (adalimumab)
›  Kineret® (anakinra)
›  Lotronex® (alosentron)
›  Provigil® (modafinil)
›  Revatio® (sildenafil citrate)
›  Sancuso® (granisetron)
›  Tretinoin
›  Testosterone
›  Xenazine® (tetrabenazine)
›  Xolair® (omalizumab)
›  Zyvox® (linezolid)