UCare's MSHO 2019 Part D (Prescription Drug) Coverage
 

Members of UCare’s Minnesota Senior Health Options (MSHO) get Medicare Part D prescription drug coverage. This means that Medicare pays for part of their prescription drugs.

Our list of covered prescription drugs, also called a formulary, can be easily searched using our Formulary Search Tool. There is also an option to print the entire formulary.

The following prescription copays apply based on the person’s living situation and income level.

If you are in a nursing home, long-term care facility, or receiving home and community based services:

  • ​ You pay $0 for brand name drugs.
  • You pay $0 for generic drugs. ​

If your income is at or below 100% of federal poverty guidelines:

  • ​You pay $3.80 for brand name drugs.
  • You pay $1.25 for generic drugs. ​

If your income is over 100% of federal poverty guidelines:

  • You pay $8.50 for brand name drugs.
  • You pay $3.40 for generic drugs.​

After your yearly out-of-pocket drug costs reach $5,100, you will have no copay.

Generally, you must get your prescription drugs from contracted pharmacies in UCare’s network. To find out if your pharmacy is in UCare’s network, use the Search Network tool.

Because you have Medical Assistance, you qualify for Extra Help to pay for some of your prescription drug costs. For more information about Extra Help, call:

  • 1-800-MEDICARE (1-800-633-4227), TTY/TDD users 1-877-486-2048 (24 hours a day/7 days a week),

  • Your state Medicaid Office, or

  • The Social Security Administration at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY/TDD users should call 1-800-325-0778.

You can also find information on the Medicare, state Medicaid office, and Social Security Administration websites (external sites).

Copays and coinsurance may vary based on the level of Extra Help received. Contact us for further details.

If you get Extra Help from Medicare, your monthly Part B premium and some prescription drug costs will be lower than what you would pay if you did not get Extra Help from Medicare. The amount of Extra Help you get will determine the cost of your monthly Part B premium.

Part D prescription drug benefit documents and information

UCare's MSHO 2019 Formulary - List of Covered Drugs, Prior Authorization criteria and Step Therapy criteria.

Prescription Drug Claim Form (PDF)
Request for Medicare Prescription Drug Coverage Determination Form (PDF)
Request for Redetermination of Medicare Prescription Drug Denial Form (PDF) Updated 12/2018

Prescription Drug Transition Policy (PDF)

Medication Therapy Management Program ​ (PDF) - available to all Medicare-eligible members who meet program criteria. While not a part of a prescription drug benefit, it is a Medicare designed program sponsored by UCare.

Mail order pharmacy program

UCare members with Medicare may order up to a 90 day supply on certain medications to be delivered by mail through Express Scripts, UCare’s Pharmacy Benefits Manager. Besides convenience, benefits include free home delivery and 24/7 access to a pharmacist.

Choose one of these ways to start receiving your medications at home:

  1. Call in your prescriptions - Call 1-877-567-6320 (toll free) to speak with an Express Scripts patient care advocate who can help you get started with Home Delivery. Hours of operation are 24 hours a day, 7 days a week. TTY/TDD users should call 1-800-716-3231 (toll free). When you call, please have your ID number (found on your member ID card), your doctor's name and phone number, and a list of your current medications or medicine containers.
  1. Visit Express Scripts online - Go to Express-Scripts.com (external site) and follow the prompts.
     
  2. Ask your provider to contact Express Scripts Mail Order.

 

Medicare Savings Programs (external site)
Use this tool to find out which programs can help you.

Best Available Evidence Policy (external site)

Coverage Determinations, Appeals, and Grievances
Find out how to make a complaint if you have concerns about your Part D coverage.


Questions?

If you have any questions, please call UCare's Customer Services at

612-676-6868 or 1-866-280-7202 toll free
TTY: 1-800-688-2534 toll free

8 am to 8 pm, seven days a week


This information is not a complete description of benefits. Contact the plan for more information. Benefits, formulary, pharmacy network, provider network, premium and/or copayments/coinsurance may change on January 1 of each year.

UCare’s MSHO is a health plan that contracts with both Medicare and the Minnesota Medical Assistance (Medicaid) program to provide benefits of both programs to enrollees. Enrollment in UCare’s MSHO depends on contract renewal.)

H2456_101018 DHS Approved (10122018) CMS Approved (10302018)
September 2018