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

 

Individual & Family Plans Formulary (PDF) Updated 04/01/2019

Tier What you pay when using in-network pharmacy
Tier 1
Preferred generic drugs
$25 copay per 30-day supply,
$50 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 04/01/2019
Step Therapy Criteria (PDF)  Updated 02/01/2019

Specialty Pharmacy Drug List (PDF) Updated 04/01/2018


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.