UCare's MSHO 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 12/1/22
UCare's MSHO and UCare Connect + Medicare List of Covered Drugs (Formulary) - Hmong (PDF) Updated 12/1/22
UCare's MSHO and UCare Connect + Medicare List of Covered Drugs (Formulary) - Somali (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 6/24/22
Diabetic Supplies List (PDF) Updated 8/11/22
Part B Medical Injectable Drug Authorization List (PDF) Updated 11/15/22
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 |