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UCare's MSHO and UCare Connect + Medicare List of Covered Drugs (Formulary) (PDF) Updated 10/4/22
UCare's MSHO and UCare Connect + Medicare List of Covered Drugs (Formulary) - Hmong (PDF) Coming soon
UCare's MSHO and UCare Connect + Medicare List of Covered Drugs (Formulary) - Somali (PDF) Coming soon

Prior Authorization Criteria (PDF) 10/11/22
Step Therapy Criteria (PDF) 10/11/22
UCare Formulary Exception Criteria (PDF) Updated 10/1/22

Diabetic Supplies List (PDF) Updated 10/1/22
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 $1.45 to $4.15 copay for a 30-day supply, depending on your income and level of Medical Assistance (Medicaid) eligibility
Tier 1
Brand drugs
$0 copay or $4.30 to $10.35 copay for a 30-day supply, depending on your income and level of Medical Assistance (Medicaid) eligibility
Over-the-Counter $0 copay


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.