Prepaid Medical Assistance Program (PMAP) 2025 Formulary (List of Covered Prescription and Over-the-Counter Drugs)
Download the complete Formulary or search the list of covered drugs below.
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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 | Copay Amount |
|---|---|
| Tier 1 Generic drugs |
$0 copay |
| Tier2 Brand drugs |
$0 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
Formulary documents and information
| Documents | Last updated Date |
|---|---|
| Minnesota Health Care Programs List of Covered Drugs (Formulary) (PDF) | 8/1/2025 |
| Minnesota Health Care Programs List of Covered Drugs (Formulary) - Arabic (PDF) | 8/1/2025 |
| Minnesota Health Care Programs List of Covered Drugs (Formulary) - Hmong (PDF) | 8/1/2025 |
| Minnesota Health Care Programs List of Covered Drugs (Formulary) - Russian (PDF) |
8/1/2025 |
| Minnesota Health Care Programs List of Covered Drugs (Formulary) - Somali (PDF) | 8/1/2025 |
| Minnesota Health Care Programs List of Covered Drugs (Formulary) - Spanish (PDF) | 8/1/2025 |
| Prior Authorization Criteria | 1/1/2025 |
| Diabetes Supply List (PDF) | 5/1/2024 |
| Medical Injectable Authorization List (PDF) | 8/12/2025 |
| 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. |