Individual & Family Plans
UCare Silver and UCare M Health Fairview Silver
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
$10 copay per 30-day supply; $20 copay for up to 90-day supply
Tier 2
Non-preferred generics
$20 copay per 30-day supply; $40 copay for up to 90-day supply
Tier 3
Preferred Brand drugs
$175 copay per 30-day supply; Formulary insulin $25 copay per 30-day supply
Tier 4
Non-preferred brand drugs
40% coinsurance after deductible
Tier 5
Specialty drugs
40% coinsurance after deductible

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


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

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