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UCare Medicare Group Plans - nVent / Pentair 2023 Formulary (List of Covered Drugs)

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

Tier Deductible 30 day supply cost share 90 day supply cost share
Tier 1
Generic drugs
Deductible does not apply to this tier $10 copay Available for two copays through mail order or a preferred network pharmacy
Tier 2
Preferred brand-name drugs
$100 $40 copay Available for two copays through mail order or a preferred network pharmacy
Tier 3
Non-preferred drugs
$100 $100 copay Available for two copays through mail order or a preferred network pharmacy
Tier 4
Specialty drugs
$100 30% coinsurance Available for 30% coinsurance

Important Message About What You Pay for Vaccines - Our plan covers most Part D vaccines at no cost to you, even if you haven’t paid your deductible. Call Customer Service for more information.


Important Message About What You Pay for Insulin - You won’t pay more than $35 for a one-month supply of each insulin product covered by our plan, no matter what cost-sharing tier it’s on, even if you haven’t paid your deductible.