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 9/1/2023
UCare Your Choice Formulary (List of Covered Drugs) - Spanish (PDF) Updated 9/1/2023
Prior Authorization Criteria (PDF) Updated 9/1/2023
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
Part B Medical Injectable Drug Authorization List (PDF) Updated 8/24/2023
|Tier||Deductible||30 day supply - preferred cost share||30 day supply - Standard cost share||90 day supply - preferred mail order|
Preferred generic drugs
|Deductible does not apply to this tier
||$0 copay||$15 copay||Two preferred copays|
|Deductible does not apply to this tier||$12 copay||$20 copay||Two preferred copays|
Preferred brand drugs
|$245||25% coinsurance||25% coinsurance||25% coinsurance|
|$245||50% coinsurance||50% coinsurance||50% coinsurance|
|$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.