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UCare Medicare Group Plans - Rosemount-Apple Valley Schools High Option 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 30 day supply cost share 100 day supply cost share
Tier 1
Generic drugs
$0 copay Available for two copays through mail order or a retail network pharmacy
Tier 2
Preferred brand-name drugs
$30 copay Available for two copays through mail order or a retail network pharmacy
Tier 3
Non-preferred drugs
$60 copay Available for two copays through mail order or a retail network pharmacy
Tier 4
Specialty drugs
$60 copay Limited to 30-day supply per fill

Important Message About What You Pay for Vaccines - Our plan covers most Part D vaccines at no cost to you. 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.


 

More formulary information

Questions? Call a UCare expert.

Contact our customer service team for assistance

Customer Service