Your Choice 2023 Formulary (List of Covered Drugs)
Download the complete Formulary or search the list of covered drugs below.
UCare Your Choice Formulary (List of Covered Drugs) (PDF) Updated 3/1/23
UCare Your Choice Formulary (List of Covered Drugs) - Spanish (PDF) Updated 3/1/23
Prior Authorization Criteria (PDF)
Step Therapy Criteria (PDF)
UCare Formulary Exception Criteria (PDF) Updated 10/1/22
Formulary Change Notice (PDF) Updated 1/11/2023
Part B Medical Injectable Drug Authorization List (PDF) Updated 1/24/23
| Tier | Deductible | 30 day supply - preferred cost share | 30 day supply - Standard cost share | 90 day supply - preferred mail order |
| Tier 1 Preferred generic drugs |
Deductible does not apply to this tier |
$0 copay | $15 copay | Two preferred copays |
| Tier 2 Generic drugs |
Deductible does not apply to this tier | $12 copay | $20 copay | Two preferred copays |
| Tier 3 Preferred brand drugs |
$245 | 25% coinsurance | 25% coinsurance | 25% coinsurance |
| Tier 4 Non-preferred drugs |
$245 | 50% coinsurance | 50% coinsurance | 50% coinsurance |
| Tier 5 Specialty drugs |
$245 | 29% coinsurance | 29% coinsurance | 29% 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.