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UCare's MSHO 2024 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 $4.60 for brand name drugs
  • You pay $1.55 for generic drugs

If your income is over 100% of federal poverty guidelines:

  • You pay $11.20 for brand name drugs
  • You pay $4.50 for generic drugs.

After your yearly out-of-pocket drug costs reach $8,000, you will have no copay.

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 Medicaid (Medical Assistance), 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 users call 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, 7 am – 7 pm, Monday – Friday. TTY users call 1-800-325-0778.

You can also find information on the Medicare, state Medicaid office and Social Security Administration websites.

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 2024 Formulary - List of Covered Drugs, Prior Authorization criteria and Step Therapy criteria.

Prescription Drug Claim Form (PDF)
Request for Medicare Prescription Drug Coverage Determination Form (PDF)
Request for Redetermination of Medicare Prescription Drug Denial Form (PDF)

Prescription Drug Transition Policy (PDF) (Coming soon)

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

Beginning in 2024, Costco Mail Order Pharmacy will be our network mail order delivery program. Save time with free home delivery from Costco Mail Order Pharmacy and you don’t need to be a Costco member to use this service. You may order an extended day supply of some medications and it may cost less than at a retail pharmacy.

Before Costco Mail Order Pharmacy can begin filling your prescriptions, you will need to have or create a Costco account and create a Costco Mail Order Pharmacy patient profile. Go to the Costco Mail Order Pharmacy website and click “Get Started” or call 1-800-607-6861 (TTY users call 711). You will need your pharmacy billing information — RxBIN, RxPCN and Rx Group — found on your 2024 member identification (ID) card to complete the patient profile.

Once you have an account and patient profile, choose one of these ways to start getting your drugs at home:

  • Call in your prescriptions at 1-800-607-6861 (TTY users call 711).
  • Submit your prescriptions at
  • Ask your provider to contact Costco Mail Order Pharmacy.

For refills of your mail order prescriptions, you have the option to sign up for an automatic refill reminder program. Typically, you should expect to receive your prescription drugs within 14 days from the time the mail order pharmacy receives the order.

Additional resources

Best Available Evidence Policy

Coverage Determinations Appeals and Grievances
Find out how to make a complaint if you have concerns about your Part D coverage.


If you have any questions, please call UCare's Customer Service at

612-676-6868 or 1-866-280-7202
TTY: 1-800-688-2534

8 am – 8 pm, seven days a week

UCare's Minnesota Senior Health Options (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.