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UCare Medicare Prime 2021 Formulary (List of Covered Drugs)

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

Tier Deductible 30 day supply - standard cost share 30 day supply - preferred cost share 90 day supply - preferred mail order
Tier 1
Preferred generic drugs
Deductible does not apply to this tier $12 copay $3 copay Available for two preferred copays
Tier 2
Generic drugs
$445 $20 copay $10 copay Available for two preferred copays
Tier 3
Preferred brand drugs
$445 25% coinsurance 17% coinsurance Available for 17% coinsurance
Select insulins Deductible does not apply to select insulin $35 copay $30 copay
Tier 4
Non-preferred brand drugs
$445 50% coinsurance 45% coinsurance Available for 45% coinsurance
Tier 5
Specialty drugs
$445 25% coinsurance 25% coinsurance Available for 25% coinsurance



Tier Deductible 30 day supply - standard cost share 30 day supply - preferred cost share 90 day supply - preferred mail order
Tier 1
Preferred generic drugs
Deductible does not apply to this tier $12 copay $3 copay Available for two preferred copays
Tier 2
Generic drugs
$445 25% coinsurance 20% coinsurance Available for two preferred copays
Tier 3
Preferred brand drugs
$445 25% coinsurance 20% coinsurance Available for 20% coinsurance
Select insulins Deductible does not apply to select insulin $35 copay $30 copay
Tier 4
Non-preferred brand drugs
$445 50% coinsurance 45% coinsurance Available for 45% coinsurance
Tier 5
Specialty drugs
$445 25% coinsurance 25% coinsurance Available for 25% coinsurance