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2016 Prescription Drug Coverage                        

UCare for Seniors Classic, Value Plus, and Essentials Rx members have Medicare prescription drug coverage included in their plans. We give you all the coverage you want in one comprehensive plan. It's easy.

 Value     Essentials Rx​       Value Plus       Classic

Medicare Part D
prescription drug coverage

Not covered

  • $100 deductible
  • Copays based
    on drug tiers
  • $50 deductible
  • Copays based
    on drug tiers

  • No deductible
  • Copays based
    on drug tiers

  • More coverage for
    generics in gap


A Guide to Comparing Your Options (PDF)
Turn to page 29 for detailed information on the prescription coverage included with each plan option including tiers, copays, and coverage in the Part D gap.

Comprehensive Formulary (PDF) (Updated 10/2015)
Look up your prescription drugs in UCare's drug list.

Do you qualify for Extra Help with your prescription drug costs? 

If you get Extra Help from Medicare to help pay for your Medicare prescription drug plan costs, your monthly plan premium with UCare will be lower than what it would be if you did not get Extra Help from Medicare. The amount of Extra Help you get will determine your total monthly plan premium as a member of our plan.

This table shows you what your UCare monthly plan premium will be if you get Extra Help.  

Your level of
Extra Help
Monthly premium*   
Value Plus
Essential Rx
*This does not include any Medicare Part B premium you may have to pay.

This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments and restrictions may apply. Benefits, premiums and/or copayments/coinsurance may change on January 1 of each year.

UCare's premium includes coverage for both medical services and prescription drug coverage. 

If you aren't getting Extra Help, you can see if you qualify by calling: 

  • 1-800-MEDICARE (1-800-633-4227), TTY/TDD users 1-877-486-2048 (24 hours a day/7 days a week),
  • Your state Medicaid Office, or
  • The Social Security Administration at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY/TDD users should call 1-800-325-0778.

You can also find information on the Medicare website (external site).

If you have any questions, please call UCare's Customer Services at 1-877-523-1515 toll free, 
TTY 1-800-688-2534 toll free, 24 hours a day, seven days a week.

Medicare Savings Programs (external site)
Use this tool to find out which programs can help you.  

Current Members 

The documents and information you need to understand your Part D prescription drug benefits.

Best Available Evidence Policy (external site)
Prescription Drug Claims Form (PDF)

Prior Authorization Criteria (Updated 10/2015)

Step Therapy Criteria (Updated 10/2015)

Formulary Removals and Changes (coming soon)

Formulary Additions and Changes (coming soon)

Request for Medicare Prescription Drug Coverage Determination Form (PDF)

Prescription Drug Transition Policy (2016 details not yet available)
Medication Therapy Management Program​ (2016 details not yet available)
The Medication Therapy Management Program is available to all Medicare members.
It is not a UCare for Seniors benefit.

Mail order pharmacy program

UCare members with Medicare can order certain medications by mail through Express Scripts, UCare’s Pharmacy Benefits Manager. Benefits include free home delivery, safe and reliable, and professional service 24/7.

Choose one of three easy ways to start receiving your medications at home:

1.  Mail in your prescriptions

Simply complete and mail an Express Scripts Pharmacy order form with a 90-day prescription from your doctor for each maintenance medication (with up to one year of refills, if appropriate). To get an order form, contact Express Scripts at
1-877-567-6320 (TTY 1-800-899-2114). You can also get a form by contacting UCare Customer Services.

2.  Call in your prescriptions

Call 1-877-567-6320 to speak with an Express Scripts patient care advocate who can help you get started with Home Delivery. Hours of operation are 7:45 a.m. to 5 p.m., Monday through Friday. TTY/TDD users should call 1-800-899-2114. When you call, please have your ID number (found on your member ID card), your doctor's name and phone number, and a list of your current medications or medicine containers.

3.  Visit Express Scripts online

Go to (external site) and follow the prompts.