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UCare's MSHO 2021 Part D (Prescription Drug) Coverage

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 Program (PDF) - 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 for the cost of two copays on certain medications to be delivered by mail through Express Scripts, UCare’s Pharmacy Benefits Manager. 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 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.


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 – 5 pm, Monday through Friday

UCare’s MSHO 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.