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Individual & Family Plans UCare Bronze HSA and UCare M Health Fairview Bronze HSA 2025 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 drugs
0% coinsurance after deductible;
$25 copay for up to 30-day supply of insulin on the formulary
Tier 4
Non-preferred drugs
0% coinsurance after deductible
Tier 5
Specialty drugs
0% coinsurance after deductible


 

More formulary information

Documents Last Updated Date
Individual & Family Plans Formulary (PDF) 10/4/2024
UCare Formulary Exception Criteria (PDF) 4/1/2024
Prior Authorization Criteria Coming soon
Diabetic Supplies List (PDF) 5/1/2024
Medical Injectable Drug Authorization List (PDF) 10/11/2024
Medication Therapy Management (MTM) – available at no additional cost to members with chronic health conditions who take multiple medicines
 

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