Individual & Family Plans
UCare Silver and UCare Fairview Silver
2019 Formulary (List of Covered Drugs)

 

Individual & Family Plans Formulary (PDF) Updated 10/01/2019

Tier What you pay when using in-network pharmacy
Tier 1
Preferred generic drugs
$12 copay per 30-day supply,
$24 copay for up to 90-day supply
Tier 2
Non-preferred generics preferred brand drugs, and specialty drugs
40% coinsurance after deductible
Tier 3
Eligible as preventive drug
$0 copay

Prior Authorization Criteria (PDF) Updated 10/01/2019
Step Therapy Criteria (PDF)  Updated 02/01/2019

Search the list of covered medications below or download the complete Formulary.