Your Choice Plus 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 | $10 copay | $20 copay | Two preferred copays |
| Tier 3 Preferred brand drugs |
Deductible does not apply to this tier | $47 copay | $47 copay | Two preferred copays |
| Tier 4 Non-preferred drugs |
$200 | 50% coinsurance | 50% coinsurance | 50% coinsurance |
| Tier 5 Specialty drugs |
$200 | 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.