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 12/1/2023
UCare Your Choice Formulary (List of Covered Drugs) - Spanish (PDF) Updated 12/12/2023
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
Part B Medical Injectable Drug Authorization List (PDF) Updated 11/28/2023
| 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.