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UCare Connect + Medicare 2022 List of Covered Drugs (Formulary)

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

UCare's MSHO and UCare Connect + Medicare List of Covered Drugs (Formulary) (PDF) Updated 10/5/21

Prior Authorization Criteria (PDF) Updated 10/15/251

Diabetic Supplies List (PDF)
Part B Medical Injectable Drug Authorization List (PDF) Updated 10/1/21

MSHO Part D Information
UCare Connect + Medicare Part D Information











Tier Copay Amount
Tier 1
Generic drugs		 $0 copay or $1.35 to $3.95 copay for a 30-day supply,
depending on your income and
level of Medical Assistance (Medicaid) eligibility
Tier 1
Brand drugs		 $0 copay or $4.00 to $9.85 copay for a 30-day supply,
depending on your income and
level of Medical Assistance (Medicaid) eligibility
Over-the-Counter $0 copay