UCare Medicare Classic 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

Diabetic Supply List (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

Prescription Drug Calculator

Tier	30 day supply - standard cost share	30 day supply - preferred cost share	90 day supply - preferred mail order
Tier 1 Preferred generic drugs	$10 copay	$0 copay	Available for two preferred copays
Tier 2 Generic drugs	$17 copay	$7 copay	Available for two preferred copays
Tier 3 Preferred brand drugs	$45 copay	$35 copay	Available for two preferred copays
Select insulins	$35 copay	$30 copay	Available for two preferred copays
Tier 4 Non-preferred drugs	45% coinsurance	45% coinsurance	Available for 45% coinsurance
Tier 5 Specialty drugs	33% coinsurance	33% coinsurance	Available for 33% coinsurance

Important Message About What You Pay for Vaccines - Our plan covers most Part D vaccines at no cost to you. 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.