Care Wise: M Health Fairview & North Memorial 2023 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 12/1/2023
UCare Medicare and EssentiaCare Formulary (List of Covered Drugs) - Spanish (PDF) Updated 12/12/2023
Prior Authorization Criteria (PDF) Updated 12/1/2023
Step Therapy Criteria (PDF) Updated 3/1/2023
UCare Formulary Exception Criteria (PDF) Updated 10/1/2022
Formulary Change Notice (PDF) Updated 8/1/2023
Part B Medical Injectable Drug Authorization List (PDF) Updated 11/28/2023
UCare Medicare Part D Information
EssentiaCare Part D Information
UCare Advocate 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 |
$12 copay | $3 copay | Available for two preferred copays |
| Tier 2 Generic drugs |
$480 | $20 copay | $15 copay | Available for two preferred copays |
| Tier 3 Preferred brand drugs |
$480 | 25% coinsurance |
17% coinsurance | Available for 17% coinsurance |
| Select insulins | Deductible does not apply to select insulin | $35 copay | $30 copay | |
| Tier 4 Non-preferred drugs |
$480 | 50% coinsurance | 50% coinsurance | Available for 50% coinsurance |
| Tier 5 Specialty drugs |
$480 | 25% coinsurance | 25% coinsurance | Available for 25% 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.