UCare Medicare Group Plans - State of Minnesota 2022 Formulary (List of Covered Drugs)
Download the complete Formulary or search the list of covered drugs below.
Group Medicare Formulary (List of Covered Drugs) (PDF) Updated 12/1/22
Prior Authorization Criteria (PDF) Updated 12/1/22
UCare Formulary Exception Criteria (PDF) Updated 1/21/22
Formulary Change Notice (PDF) Updated 8/18/22
Part B Medical Injectable Drug Authorization List (PDF) Updated 11/15/22
Tier | 30 day supply cost share | 90 day supply cost share |
Tier 1 Generic drugs |
$10 copay | Available for two copays through mail order or a preferred network pharmacy |
Tier 2 Preferred brand-name drugs |
$30 copay | Available for two copays through mail order or a preferred network pharmacy |
Tier 3 Non-preferred drugs |
$50 copay | Available for two copays through mail order or a preferred network pharmacy |
Tier 4 Specialty drugs |
$50 copay | Available for two copays through mail order or a preferred network pharmacy |