Medicare Advantage and Special Needs Plans

Formularies

UCare for Seniors Medicare Advantage: Individual Part D Plans
[Care Type = Value Plus or Classic on the member ID card]
›   2010 Value Plus and Classic Formulary
›   2010 Changes to the Value Plus and Classic Formulary

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 Formulary
›   2010 Changes to the SNP 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 1-877-837-5922.  

›   Part D Prior Authorization Form

Member Reimbursement Claim Form for Part D Drugs

›   Part D Member Claim Form for UCare for Seniors