Prepaid Medical Assistance Program (PMAP) 2023 Formulary (List of Covered Prescription and Over-the-Counter Drugs)
Download the complete Formulary or search the list of covered drugs below.
Minnesota Health Care Programs List of Covered Drugs (Formulary) (PDF) Updated 12/1/2023
Minnesota Health Care Programs List of Covered Drugs (Formulary) - Arabic (PDF) Updated 12/1/2023
Minnesota Health Care Programs List of Covered Drugs (Formulary) - Hmong (PDF) Updated 12/1/2023
Minnesota Health Care Programs List of Covered Drugs (Formulary) - Russian (PDF) Updated 12/1/2023
Minnesota Health Care Programs List of Covered Drugs (Formulary) - Somali (PDF) Updated 12/1/2023
Minnesota Health Care Programs List of Covered Drugs (Formulary) - Spanish (PDF) Updated 12/1/2023
Minnesota Health Care Programs List of Covered Drugs (Formulary) - Vietnamese (PDF) Updated 12/1/2023
Prior Authorization Criteria (PDF) Updated 12/1/2023
Diabetes Supply List (PDF) Updated 5/1/2023
Medical Injectable Authorization List (PDF) Updated 12/1/2023
Continuation of Therapy Prior Authorization Criteria (PDF)
Non-Preferred Drug Prior Authorization Criteria (PDF)
Medication Therapy Management (MTM) - available at no additional cost to members with chronic health conditions who take multiple medicines.
| Tier | Copay Amount |
| Tier 1 Generic drugs |
$1 copay |
| Tier 1 Brand drugs |
$3 copay |
Note:
- No co-pays for pregnant women, children under 21, members in hospice, members residing in a nursing home for 30+ days, or adult members of a federally-recognized American Indian tribe.
- No co-pays for anti-psychotic drugs
- Copay Amount can vary based on income, call Customer Service to verify your copay.
- 90-day supply available for drugs identified on UCare’s List of Covered Drugs