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

Individual & Family Plans UCare Core 2021 Formulary (List of Covered Drugs)

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

Individual & Family Plans Formulary (PDF) Updated 10/1/21

UCare Formulary Exception Criteria (PDF) Updated 9/9/21

Prior Authorization Criteria (PDF) Updated 10/1/21

Medication Therapy Management (MTM) - available at no additional cost to members with chronic health conditions who take multiple medicines



Tier What you pay when using in-network pharmacy
Tier 1
Preferred generic drugs
0% coinsurance after deductible
Tier 2
Non-preferred generics
0% coinsurance after deductible
Tier 3
Preferred Brand drug
0% coinsurance after deductible
Tier 4
Non-preferred Brand drugs
0% coinsurance after deductible; Formulary insulin $25 copay per 30-day supply
Tier 5
Specialty drugs
0% coinsurance after deductible