UCare's MSHO 2023 List of Covered Drugs (Formulary)
Download the complete Formulary or search the list of covered drugs below.
UCare's MSHO and UCare Connect + Medicare List of Covered Drugs (Formulary) (PDF) Updated 12/1/2023
UCare's MSHO and UCare Connect + Medicare List of Covered Drugs (Formulary) - Hmong (PDF) Updated 12/1/2023
UCare's MSHO and UCare Connect + Medicare List of Covered Drugs (Formulary) - Somali (PDF) Updated 12/1/2023
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 Supplies List (PDF) Updated 8/1/2023
Part B Medical Injectable Drug Authorization List (PDF) Updated 11/28/2023
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.