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EssentiaCare 2022 Part D (Prescription Drug) Coverage

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. The amount of Extra Help you get will determine your total monthly plan premium as a member of our plan.

EssentiaCare's premium includes coverage for both medical services and prescription drug coverage in many plan options.

If you aren't getting Extra Help and have limited resources, you can find out if you qualify by calling:

  • 1-800-MEDICARE (1-800-633-4227), TTY/TDD users 1-877-486-2048 (24 hours a day/ 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.gov and Social Security Administration websites.



Part D prescription drug benefit documents and information

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

Prescription Drug Calculator

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 10/2021)

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.





This table shows you what your 2022 UCare monthly plan premium will be if you get Extra Help:

Your level of Extra Help Monthly premium* - Secure Monthly premium* - Grand
 100% $34.20 $91.10
 75% $34.40 $95.60
 50% $34.60 $100.00
 25% $34.80 $104.50

*This does not include any Medicare Part B premium you may have to pay.





Mail order pharmacy program

EssentiaCare members with Medicare may order up to a 90 day supply for the cost of two copays on certain medications to be delivered by mail through Express Scripts. 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:



  1. 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.
  1. Visit Express Scripts online - Go to Express-Scripts.com and follow the prompts.
  2. Ask your provider to contact Express Scripts Mail Order.

Medicare Savings Programs
Use this tool to find out which programs can help you.

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.

Questions?

If you're have any questions, please call UCare's Customer Service at
1-877-523-1515 toll free
TTY: 1-800-688-2534 toll free

24 hours a day, seven days a week

This information is not a complete description of benefits. Contact the plan for more information. Benefits, formulary, pharmacy network, provider network, premium and/or copayments/coinsurance may change on January 1 of each year.