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UCare Medicare Classic 2023 Formulary (List of Covered Drugs)

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

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
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.