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Individual & Family Plans UCare Core and UCare M Health Fairview Core 2024 Formulary (List of Covered Drugs)

Download the complete Formulary or search the list of covered drugs below.

Follow these steps to see the coverage and cost of your medication.

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Find out what tier your medication is

Use the drug search tool below to see whether your medication is covered and what tier it is

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Find out how much your medication costs

Use this tier table to see how much your medication costs

Tier What you pay when using in-network pharmacy
Tier 1
Preferred generic drugs
0% coinsurance after deductible
Tier 2
Non-preferred generics
0% coinsurance after deductible
Tier 3
Preferred Brand drug
0% coinsurance after deductible
Tier 4
Non-preferred Brand drugs
0% coinsurance after deductible; Formulary insulin $25 copay per 30-day supply
Tier 5
Specialty drugs
0% coinsurance after deductible


More formulary information

Documents Last Updated Date
Individual & Family Plans Formulary (PDF) 10/27/2023
UCare Formulary Exception Criteria (PDF) 10/1/2022
Prior Authorization Criteria (PDF) 10/1/2023
Diabetic Supplies List (PDF) 5/1/2023
Medical Injectable Drug Authorization List (PDF) 10/05/2023
Medication Therapy Management (MTM) – available at no additional cost to members with chronic health conditions who take multiple medicines

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