UCare Medicare Group Plans - State of Minnesota 2025 Formulary (List of Covered 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 | 30 day supply cost share | 90 day supply cost share |
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| Tier 1 Preferred generic drugs |
$0 copay | Available for two copays through mail order or a preferred network pharmacy |
| Tier 2 Generic drugs |
$0 copay | Available for two copays through mail order or a preferred network pharmacy |
| Tier 3 Preferred brand-name drugs |
$30 copay | Available for two copays through mail order or a preferred network pharmacy |
| Tier 4 Non-preferred drugs |
$50 copay | Available for two copays through mail order or a preferred network pharmacy |
| Tier 5 Specialty drugs |
$50 copay | Available for two copays through mail order or a preferred network pharmacy |
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.
Formulary documents and information
| Document | Last Updated Date |
|---|---|
| Group Medicare Formulary (List of Covered Drugs) (PDF) | 8/1/2025 |
| Group Medicare Formulary (List of Covered Drugs) Spanish (PDF) | 8/1/2025 |
| Prior Authorization Criteria (PDF) | 8/1/2025 |
| UCare Formulary Exception Criteria (PDF) | 4/28/2025 |
| Formulary Change Notice (PDF) | Coming soon |
| Diabetic Supply List (PDF) | 12/4/2024 |
| Non-Preferred CGM and Testing Criteria (PDF) | 10/1/2024 |
| Part B Medical Injectable Drug Authorization List (PDF) | 8/12/2025 |
| Part D Information |