Skip to navigation Skip to content Skip to footer
spark light blue

UCare Medicare Group Plans - Single Option High 2021 Formulary (List of Covered Drugs)

Download the complete Formulary or search the list of covered drugs below.

Tier Deductible 30 day supply cost share 90 day supply cost share
Tier 1
Generic drugs
Deductible does not apply to this tier $10 copay Available for two copays through mail order or a preferred network pharmacy
Tier 2
Preferred brand-name drugs
$100 $40 copay Available for two copays through mail order or a preferred network pharmacy
Tier 3
Non-preferred drugs
$100 $100 copay Available for two copays through mail order or a preferred network pharmacy
Tier 4
Specialty drugs
$100 30% coinsurance Available for 30% coinsurance