UCare's MSHO 2021 Part D (Prescription Drug) Coverage
Members of UCare’s Minnesota Senior Health Options (MSHO) (HMO D-SNP) get Medicare Part D prescription drug coverage. This means that Medicare pays for most of their prescription drugs.
Our list of covered prescription drugs, also called a formulary, can be easily searched using our Formulary Search Tool. There is also an option to print the entire formulary.
The following prescription copays apply based on the person’s living situation and income level.
If you are in a nursing home, long-term care facility, or receiving home and community based services (waiver services):
- You pay $0 for brand name drugs
- You pay $0 for generic drugs
If your income is at or below 100% of federal poverty guidelines:
- You pay $4.00 for brand name drugs
- You pay $1.30 for generic drugs
If your income is over 100% of federal poverty guidelines:
- You pay $9.20 for brand name drugs
- You pay $3.70 for generic drugs.
After your yearly out-of-pocket drug costs reach $6,550, you will have no copay.
Copays may be higher for 90-day supplies.
Generally, you must get your prescription drugs from pharmacies in UCare’s network. To find out if your pharmacy is in UCare’s network, use the Search Network tool.
Because you have Medical Assistance (MA), you qualify for Extra Help to pay for some of your prescription drug costs. For more information, call:
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 (TTY 1-800-325-0778), 7 am - 7 pm, Monday -Friday
Copays and coinsurance may vary based on the level of Extra Help received. Contact us for further details.
If you get Extra Help from Medicare, your monthly Part B premium and some prescription drug costs will be lower than what you would pay if you did not get Extra Help from Medicare. The amount of Extra Help you get will determine the cost of your monthly Part B premium.
Part D prescription drug benefit documents and information
UCare's MSHO 2021 Formulary - List of Covered Drugs, Prior Authorization criteria and Step Therapy criteria.
Prescription Drug Claim Form (PDF) (Updated 12/2020)
Request for Medicare Prescription Drug Coverage Determination Form (PDF) (Updated 12/2020)
Request for Redetermination of Medicare Prescription Drug Denial Form (PDF) (Updated 12/2020)
Prescription Drug Transition Policy (PDF) (Updated 12/2020)
Medication Therapy Management (MTM) - available to all Medicare-eligible members who meet program criteria. While not a part of a prescription drug benefit, it is a Medicare designed program sponsored by UCare.
Mail order pharmacy program
UCare Medicare members may order up to a 90-day supply of medication by mail through Express Scripts, UCare’s Pharmacy Benefits Manager. It may cost less than a 90-day supply at a retail pharmacy. Besides convenience, benefits include free home delivery and 24/7 access to a pharmacist.
Choose one of these ways to start receiving your medications at home:
- Call in your prescriptions - Call 1-877-567-6320 (toll free) to speak with an Express Scripts Patient Care Advocate who can help you get started with home delivery. Hours of operation are 24 hours a day, 7 days a week. TTY/TDD users should call 1-800-716-3231 (toll free). 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.
- Visit Express Scripts online - Go to Express-Scripts.com and follow the prompts.
- Ask your provider to contact Express Scripts Mail Order.
UCare’s MSHO (HMO D-SNP) is a health plan that contracts with both Medicare and the Minnesota Medical Assistance (Medicaid) program to provide benefits of both programs to enrollees. Enrollment in UCare’s MSHO depends on contract renewal.