EssentiaCare Grand 2022 Formulary (List of Covered Drugs)
Download the complete Formulary or search the list of covered drugs below.
UCare Medicare and EssentiaCare 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
Part D Information
EssentiaCare Part D Information
| 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 | $10 copay | $1 copay | Available for two preferred copays |
| Tier 2 Generic drugs |
Deductible does not apply to this tier | $17 copay | $7 copay | Available for two preferred copays |
| Tier 3 Preferred brand drugs |
$250 | $45 copay | $35 copay | Available for two preferred copays |
| Select insulins | Deductible does not apply to select insulin | $35 copay | $30 copay | |
| Tier 4 Non-preferred drugs |
$250 | 50% coinsurance | 50% coinsurance | Available for 50% coinsurance |
| Tier 5 Specialty drugs |
$250 | 28% coinsurance | 28% coinsurance | Available for 28% coinsurance |