Prescription drug benefits

There are several reasons why you might have received a call from UCare or Navitus, our pharmacy benefit manager, about your medications. There is no additional cost for these services.

Medication Therapy Management (MTM)

Eligible members with Medicare Part D coverage may receive mail, a call or text from the UCare MTM program. MTM is a Medicare-designed program sponsored by UCare that provides members with a comprehensive medication review (CMR).

Learn more about Medication Therapy Management (MTM)

Transitions of Care (TOC)

If you are an eligible Medicare member who was recently discharged from a hospital or transitional care unit, you may receive a call from a UCare TOC pharmacist. The TOC pharmacist provides a personalized, comprehensive medication review post-discharge to help members manage their new drug regimen. The pharmacist will also reach out to the member's provider to provide an updated medication list and any suggestions for medication changes. TOC medication reviews are recommended for eligible members after every discharge.

If you have specific questions about a call you received from a Transitions of Care pharmacist, call the phone number provided in the voicemail or automated call for more information. You can also call the customer service number on the back of your health plan member ID card.

Pharmacy Navigator

A Pharmacy Navigator from the UCare Pharmacy Quality Team may reach out regarding medication adherence or to provide helpful guidance for recent formulary or benefit changes. You may receive a call regarding:

• Late refills or a gap in a refill of their cholesterol, diabetes or hypertension medication
• Medication that must be dispensed through a specialty pharmacy
• Approval of prior authorization
• Guidance to help with a new pharmacy benefit change
• Referrals for additional pharmacy-related support
• Scheduling MTM visits

Pharmacy Adherence Line

In addition to Pharmacy Navigator calls, members may receive an automated phone call from the Pharmacy Adherence Line with important messages regarding their health.

If you have specific questions about an automated call you received from the Pharmacy Adherence Line, call the phone number provided in the automated call for more information. You can also call the customer service number on the back of your health plan member ID card.

Navitus adherence calls

You may receive a call from Navitus, our pharmacy benefits manager. Their Clinical Engagement Center (CEC) is a team of pharmacists, nurses and pharmacy technicians who offer support with various pharmacy-related needs.

Also known as the list of covered drugs or drug list, a formulary is a list of drugs, chosen by a team of doctors and pharmacists, that are covered by your health plan. It’s divided into tiers, and generally drugs on lower tiers will cost less than drugs on higher tiers. The formulary can also change during the calendar year. For example, new FDA approved drugs may be added to the formulary or drugs may be removed due to a safety concern. Search for your drugs on your current plan year’s formulary.

In your online member account, you can visit our pharmacy benefit manager portal, Navitus Health Solutions. Through Navitus, you can use real-time benefit tools to price your drugs, find alternative medicines and more.

All members can check their current plan year’s documents and forms for more information about their drug costs.

For UCare Medicare Advantage and EssentiaCare members:

View the online prescription drug calculator at ucare.org/destinationrx.com/compare/MDC/2025. Use this tool to see what you can expect to pay for your medication. The calculator will help you understand your monthly and yearly drug costs. It also gives you an estimate of when you may reach your maximum out-of-pocket.

Use the pharmacy search tool to find a pharmacy in your health plan’s network.

In order for your prescription drugs to be covered by your health plan, make sure to get them from in-network pharmacies. Use our search tool to find a pharmacy in your health plan’s network.

The Transitions of Care (TOC) pharmacy service provides personalized medication reviews to eligible Medicare members who were recently discharged from a hospital or transitional care unit. A specialized pharmacist meets with the member to provide in-depth counseling of new medications added to the member’s regimen after they were discharged, look for ways to make their medication regimen simpler or more efficient and identify and resolve any of the member’s gaps in care. After the meeting, the member will receive a personalized action plan that includes a personalized medication list, defines what drug therapy problems were identified and suggests the next steps the member should take. The pharmacist will also reach out to the member’s provider to provide an updated medication list and any suggestions for medication changes.

If you have specific questions about a call you received from a Transitions of Care pharmacist, call the phone number provided in the voicemail or automated call for more information. You can also call the customer service number on the back of your health plan member ID card.

There are a number of ways for members to save money on their prescription drugs.

Make sure your drug is in your plan’s formulary

Your health plan’s drug benefits help to cover the cost of prescription drugs that are listed on your health plan’s formulary. If you’re prescribed a drug that isn’t on your health plan’s drug list and you don’t receive prior authorization from UCare, you may be responsible for paying the full cost of the medication, which can be very expensive. Search for your drugs on your current plan year’s formulary or check your current plan year’s documents and forms for more information about prior authorization. If you’re prescribed a drug that isn’t on the formulary, talk to your provider about possible alternatives that are on your plan’s drug list.

Consider generic drugs

A generic drug is a medication created to be the same as an already-marketed brand drug. That means that a generic drug works in the same way and provides the same clinical benefit as the brand-name medicine. Generic drugs are usually much cheaper than their brand-name alternative. This is because generic drug manufacturers don’t have to duplicate the original clinical trials for effectiveness and safety. The brand drug manufacturer already conducted these for the brand-name drug’s ingredients, which are the same or very similar to the generic. Talk with your provider about possible generic options for prescribed medications to lower your costs.

Use an in-network pharmacy

Staying in your health plan’s network allows you to save money. That’s because negotiated rates for health care don't apply to care received by providers outside the plan’s network. So, you’ll typically pay quite a bit more if you visit an out-of-network pharmacy. Use the pharmacy search tool to check if your pharmacy is in your health plan’s network or find one that is in-network.

See if you qualify for help

If your health plan includes Medicare Part D coverage, there are programs to help manage your prescription drug costs. The Medicare Prescription Payment Plan allows you to manage your out-of-pocket Part D prescription drug costs by spreading them out across the plan year instead of paying at the pharmacy. Also, you may qualify for Extra Help, a Medicare program that helps pay for your Medicare Part D prescription drug plan costs, monthly premium, coinsurance, deductible and more. You can find information about Extra Help on the Medicare and Social Security Administration websites or your health plan’s Part D webpage.