Individual & Family Plans
UCare Bronze HSA and UCare M Health Fairview Bronze HSA
2020 Formulary (List of Covered Drugs)

 

Individual & Family Plans Formulary (PDF) Updated 10/15/2019

Tier What you pay when using in-network pharmacy
Tier 1
Preferred generic drugs
0% coinsurance after deductible
Tier 2
Non-preferred generics
0% coinsurance after deductible
Tier 3
Preferred Brand drugs
0% coinsurance after deductible; Formulary insulin $25 copay per 30-day supply
Tier 4
Non-preferred Brand drugs
0% coinsurance after deductible
Tier 5
Specialty drugs
0% coinsurance after deductible

Prior Authorization Criteria (PDF) Updated 10/15/2019
Step Therapy Criteria (PDF)  Updated 10/15/2019


See the 2018 UCare Choices Bronze and Fairview UCare Choices Bronze Formulary (List of Covered Drugs) here.

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