Ucare formulary 2024
2024 UCare Individual & Family Plans. Here’s a summary of our plans. On MNsure, you'll find more plan details and an estimate of your subsidy based on your household details. ... Fully covered in-network preventive care and money saving health and wellness perks included with your plan; Decide between UCare’s broad network or our more focused …
Individual & Family Plans formulary (list of covered drugs) Select your plan: ... UCare is a registered service mark of UCare Minnesota | ©2024 UCare Minnesota. All ...
UCare's MSHO and UCare Connect + Medicare List of Covered Drugs (Formulary) - Somali (PDF) Updated 12/1/2023. Prior Authorization Criteria (PDF) Updated 12/1/2023. Step Therapy Criteria (PDF) Updated 3/1/2023. UCare Formulary Exception Criteria (PDF) Updated 10/1/2022. Formulary Change Notice (PDF) Updated 8/1/2023.Copay Amount. Tier 1. Generic drugs. $0 copay or $1.55 to $4.50 copay for a 30-day supply, depending on your income and level of Medical Assistance (Medicaid) eligibility. Tier 1. Brand drugs. $0 copay or $4.60 to $11.20 copay for a 30-day supply, depending on your income and level of Medical Assistance (Medicaid) eligibility. Over-the-Counter.Minnesota Health Care Programs (MHCP): UCare Connect, MinnesotaCare, PMAP, Minnesota Senior Care Plus (formulary is updated on the first of each month, 2024 formulary will be available January 1) 2024 Summary of Formulary Updates The 2024 formulary changes noted below are considered high impact. This is not an all-inclusive list of 2024 updates.All changes to the formulary will be posted on the plan’s website. How do I use the Plan’s Formulary? • Column #1: lists the covered drug. Brand drugs are in upper case letters (e.g., DRUG). Generics are in lower case letters (e.g.,drug). • Column #2: shows brand drug for the generic; brand drugs are not covered if generic equivalent is ... Tier 1. Generic drugs. $0 copay or $1.55 to $4.50 copay for a 30-day supply, depending on your income and level of Medical Assistance (Medicaid) eligibility. Tier 1. Brand drugs. $0 copay or $4.60 to $11.20 copay for a 30-day supply, depending on your income and level of Medical Assistance (Medicaid) eligibility. Over-the-Counter. UCare Medicare Group Plans - State of Minnesota 2024 Formulary (List of Covered Drugs) Download the complete Formulary or search the list of covered drugs below. Follow these steps to see the coverage and cost of your medication. Find out what tier your medication is. Use the drug search tool below to see whether your medication is covered and ...
UCare Your Choice Plans (PPO) Formulary (List of Covered Drugs) l UCare Your Choice l UCare Your Choice Plus This formulary was updated on 03/19/2024. PLEASE READ: This document contains information about the drugs we cover in these plans. For more recent information or other questions, please contact: UCare Your Choice Plans Customer Service ...Minnesota Health Care Programs (MHCP): UCare Connect, MinnesotaCare, PMAP, Minnesota Senior Care Plus (formulary is updated on the first of each month, 2024 formulary will be available January 1) 2024 Summary of Formulary Updates The 2024 formulary changes noted below are considered high impact. This is not an all-inclusive list of 2024 updates.2024 Evidence of Coverage for UCare Your Choice 13 Chapter 1. Getting started as a member SECTION 1 Introduction Section 1.1 You are enrolled in UCare Your Choice, which is a Medicare PPO You are covered by Medicare, and you have chosen to get your Medicare health care and your prescription drug coverage through our plan, UCare Your …January 2024 2024 EMPIRE PLAN ... If you continue using any of the drugs listed, you will be required to pay the full cost of non-formulary products that are excluded from coverage unless a request for a medical exception is approved. New prescription drug products may be subject to exclusion upon release to the market. If you are currently using any of the …pharmacy network, and/or copayments/coinsurance may on change January 1, 2024, and from time to time during the year. What is the UCare Your Choice Plans Formulary? A formulary is a list of covered drugs selected by UCare Your Choice Plans in …Oct 1, 2023 · Preferred generic drugs. $15 copay per prescription; $30 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. 20% coinsurance after deductible; $25 for a 30-day supply of insulin on the formulary; $25 for a 30-day supply of select diabetes ...
Search for the name of a specific health care provider such as, a doctor, dentist or specialist. Enter the first few letters of a first or last name of a provider if you are unsure of the …Prepaid Medical Assistance Program (PMAP) 2023 Formulary (List of Covered Prescription and Over-the-Counter Drugs) Download the complete Formulary or search the list of covered drugs below. Prior Authorization Criteria (PDF) Updated 12/1/2023. Diabetes Supply List (PDF) Updated 5/1/2023.Disney Cruises 2024 includes trips on the Disney Wish, Disney Fantasy and more to the Caribbean, Mexico, Castaway Cay and more. Save money, experience more. Check out our destinati...2024 UCare Advocate Plus Evidence of Coverage (PDF) 2024 UCare Advocate Choice and Advocate Plus (ISNP) Service Area Map (PDF) Questions and Answers about Health Care Directives (PDF) Each year, Medicare rates plans based on their health and drug services. In 2024, UCare's Institutional Special Needs Plans (I-SNP) received 4.5 stars.
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Once you have reached $5,030 in annual prescription drug spending (your cost plus UCare’s cost), you pay as shown. 25% of the cost of generic and brand drugs. 25% of the cost of generic and brand drugs. 25% of the cost of generic and brand drugs. Tier 1. $0 copay Up to a 30-day supply. Tier 2.2024 UCare Advocate Plus Evidence of Coverage (PDF) 2024 UCare Advocate Choice and Advocate Plus (ISNP) Service Area Map (PDF) Questions and Answers about Health Care Directives (PDF) Each year, Medicare rates plans based on their health and drug services. In 2024, UCare's Institutional Special Needs Plans (I-SNP) received 4.5 stars.UCare shares its 2024 pharmacy formulary and updates, a reminder about Medicare Part D vaccine coverage and how it is notifying impacted members and providers of changes. See the November 10 Provider Bulletin for details. Medical Drug Prior Authorization for 2024 and Preferred Product Step Therapy InformationUCare Your Choice Plus (PPO) H8070 - 002 - 0. (0 / 5) UCare Your Choice Plus (PPO) is a Medicare Advantage (Part C) Plan by UCare. Premium: $56.00. Enroll Now. This page features plan details for 2024 UCare Your Choice Plus (PPO) H8070 – 002 – 0 available in 46 Counties. IMPORTANT: This page has been updated with plan and premium data for …UCare Your Choice Formulary (List of Covered Drugs) - Spanish (PDF) Updated 12/12/2023. Prior Authorization Criteria (PDF) Updated 12/1/2023 Step Therapy Criteria (PDF) Updated 3/1/2023 UCare Formulary Exception Criteria (PDF) Updated 10/1/2022 Formulary Change Notice (PDF) Updated 8/1/2023. Diabetic Supply List …
UCare Your Choice Formulary (List of Covered Drugs) - Spanish (PDF) Updated 12/12/2023. Prior Authorization Criteria (PDF) Updated 12/1/2023 Step Therapy Criteria (PDF) Updated 3/1/2023 UCare Formulary Exception Criteria (PDF) Updated 10/1/2022 Formulary Change Notice (PDF) Updated 8/1/2023. Diabetic Supply List …2024 UCare Individual & Family Plans Formulary (List of Covered Drugs) l UCare Individual & Family Plans l UCare Individual & Family Plans with M Health Fairview This formulary may change throughout the year. Please visit ucare.org or call UCare Customer Service for the most current information.1-877-523-1515 toll-free. TTY users call 1-800-688-2534. 8 am – 8 pm, 7 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 Formulary Exception Criteria (PDF) 4/1/2024. Prior Authorization Criteria. 10/1/2023. Diabetic Supplies List (PDF) 5/1/2023. Medical Injectable Drug Authorization List (PDF) 4/1/2024. Medication Therapy Management (MTM) – available at no additional cost to members with chronic health conditions who take multiple medicines.Tier 1 Preferred generic drugs. $5 copay per prescription; $10 copay for up to 90-day supply. Tier 2 Non-preferred generics. $15 copay per 30-day supply; $30 copay for up to 90-day supply. Tier 3 Preferred Brand drugs. $125 copay per prescription; $25 for a 30-day supply of insulin on the formulary; $25 for a 30-day supply of select diabetes ...2024 UCare Individual & Family Plans Formulary (List of Covered Drugs) l UCare Individual & Family Plans l UCare Individual & Family Plans with M Health Fairview This formulary may change throughout the year. Please visit ucare.org or call UCare Customer Service for the most current information.UCare Medicare Part D information. UCare Advocate Part D information. This table shows you what your 2024 EssentiaCare monthly plan premium will be if you get Extra Help: Your level of Extra Help. Secure. Grand. Access. 100%. $12.40.Minnesota Health Care Programs (MHCP): UCare Connect, MinnesotaCare, PMAP, Minnesota Senior Care Plus (formulary is updated on the first of each month, 2024 formulary will be available January 1) 2024 Summary of Formulary Updates The 2024 formulary changes noted below are considered high impact. This is not an all-inclusive …
Minnesota Senior Care Plus (MSC+) 2024 Formulary (List of Covered Prescription and Over-the-Counter Drugs) Download the complete Formulary or search the list of covered drugs below. Follow these steps to see the coverage and cost of your medication. Find out what tier your medication is.
Prior Authorization Criteria (PDF) Updated 12/1/2023. Step Therapy Criteria (PDF) Updated 3/1/2023. UCare Formulary Exception Criteria (PDF) Updated 10/1/2022. Formulary Change Notice (PDF) Updated 8/1/2023. Diabetic Supply List (PDF) Updated 8/1/2023. Part B Medical Injectable Drug Authorization List (PDF) Updated 11/28/2023.UCare Your Choice Plans (PPO) Formulary (List of Covered Drugs) l UCare Your Choice l UCare Your Choice Plus This formulary was updated on 01/23/2024. PLEASE READ: This document contains information about the drugs we cover in these plans. For more recent information or other questions, please contact: UCare Your Choice Plans Customer Service ...In today’s fast-paced world, busy families are constantly on the move, juggling work, school, and extracurricular activities. As we look ahead to 2024, the demands on families are ...If you’re in the market for a new SUV but have a tight budget, fear not. The automotive industry is constantly evolving, and manufacturers are introducing more affordable SUV model...UCare Individual & Family Plans Provider and Pharmacy Directory 2024 This directory provides a list of UCare Individual & Family Plans network providers and pharmacies. This directory is for the UCare service area that includes these Minnesota counties: ... covered services, you should receive those services from an in-network provider. In some cases, …ANTIRHEUMATIC ANTIMETABOLITES. GOLD COMPOUNDS. INTERLEUKIN-1 BLOCKERS. INTERLEUKIN-1 RECEPTOR ANTAGONIST (IL-1RA) INTERLEUKIN-1BETA BLOCKERS. INTERLEUKIN-6 RECEPTOR INHIBITORS. NONSTEROIDAL ANTI-INFLAMMATORY AGENTS (NSAIDS) PHOSPHODIESTERASE 4 (PDE4) …4 days ago · Formulary Change Notice (PDF) 3/1/2024. Diabetic Supplies List (PDF) 8/1/2023. Part B Medical Injectable Drug Authorization List (PDF) 4/1/2024. MSHO Part D Information. UCare Connect + Medicare Part D Information.
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Tier 1. Generic drugs. $0 copay or $1.55 to $4.50 copay for a 30-day supply, depending on your income and level of Medical Assistance (Medicaid) eligibility. Tier 1. Brand drugs. $0 copay or $4.60 to $11.20 copay for a 30-day supply, depending on your income and level of Medical Assistance (Medicaid) eligibility. Over-the-Counter.Download the complete Formulary or search the list of covered drugs below. UCare Your Choice Formulary (List of Covered Drugs) (PDF) Updated 12/1/2023. UCare Your Choice Formulary (List of Covered Drugs) - Spanish (PDF) Updated 12/12/2023. Prior Authorization Criteria (PDF) Updated 12/1/2023. Step Therapy Criteria (PDF) … A formulary is a list of covered drugs selected by UCare Medicare Group Plans in consultation with a team of health care providers, which represents the prescription therapies believed to be a necessary part of a quality treatment program. 2024 UCare's Minnesota Senior Health Options Summary of Benefits. This document is a brief summary of the benefits and services covered by UCare's MSHO. It includes. answers to frequently asked questions, important contact information, an overview of benefits and. services offered, and information about your rights as a member of UCare's MSHO.UCare Formulary Exception Criteria (PDF) Updated 10/1/2022 Formulary Change Notice (PDF) Updated 8/1/2023. Diabetic Supply List (PDF) Updated 8/1/2023. Part B Medical Injectable Drug Authorization List (PDF) Updated 11/28/2023. UCare Medicare Part D Information EssentiaCare Part D Information UCare Advocate Part D Information. …UCare Medicare Group Plans Formulary (List of Covered Drugs) l UCare Medicare Group Plans (HMO-POS) This formulary was updated on 04/18/2024. PLEASE READ: This document contains information about the drugs we cover in these plans. For more recent information or other questions, please contact: UCare Medicare Group Plans Customer …2024 Evidence of Coverage for UCare Your Choice 13 Chapter 1. Getting started as a member SECTION 1 Introduction Section 1.1 You are enrolled in UCare Your Choice, which is a Medicare PPO You are covered by Medicare, and you have chosen to get your Medicare health care and your prescription drug coverage through our plan, UCare Your …UCare Formulary Exception Criteria . A formulary exception is granted if the following criteria are met. ... U11219A (03/2024) Discrimination is against the law. UCare does not discriminate because of race, color, national origin, creed, religion, sexual orientation, public assistance status, marital status, age, disability or sex. No English? 1-800-203-7225On June 1, 2024, UCare will update prior authorization criteria for drugs on the UCare Individual & Family Plans and UCare Individual & Family Plans with M Health Fairview formulary. See the April 24 Provider Bulletin for details.UCare Connect 2024 Formulary (List of Covered Prescription and Over-the-Counter Drugs) Download the complete Formulary or search the list of covered drugs below. Follow these steps to see the coverage and cost of your medication. Find out what tier your medication is. Use the drug search tool below to see whether your medication …Oct 1, 2023 · UCare Formulary Exception Criteria (PDF) 4/1/2024. Prior Authorization Criteria. 10/1/2023. Diabetic Supplies List (PDF) 5/1/2023. Medical Injectable Drug Authorization List (PDF) 4/1/2024. Medication Therapy Management (MTM) – available at no additional cost to members with chronic health conditions who take multiple medicines. ANTIRHEUMATIC ANTIMETABOLITES. GOLD COMPOUNDS. INTERLEUKIN-1 BLOCKERS. INTERLEUKIN-1 RECEPTOR ANTAGONIST (IL-1RA) INTERLEUKIN-1BETA BLOCKERS. INTERLEUKIN-6 RECEPTOR INHIBITORS. NONSTEROIDAL ANTI-INFLAMMATORY AGENTS (NSAIDS) PHOSPHODIESTERASE 4 (PDE4) … ….
Individual & Family Plans formulary (list of covered drugs) Select your plan: ... UCare is a registered service mark of UCare Minnesota | ©2024 UCare Minnesota. All ... 2024 UCare Medicare and EssentiaCare list of covered drugs (formulary) with cost estimates. UCare Medicare and EssentiaCare plans. UCare Medicare Plans (HMO …Review the 2024 Pharmacy Directory online to see which pharmacies are in our network next year. Drug List (Formulary) You can look up which drugs will be covered by your …The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary. We will notify affected enrollees about changes at least 30 days ... 2024 Evidence of Coverage for UCare Complete Metro 13 Chapter 1. Getting started as a member SECTION 1 Introduction Section 1.1 You are enrolled in UCare …2024 UCare Medicare and EssentiaCare list of covered drugs (formulary) with cost estimates. UCare Medicare and EssentiaCare plans. UCare Medicare Plans (HMO …2024 UCare Individual & Family Plans Formulary (List of Covered Drugs) l UCare Individual & Family Plans l UCare Individual & Family Plans with M Health Fairview This formulary may change throughout the year. Please visit ucare.org or call UCare Customer Service for the most current information.UCare shares its 2024 pharmacy formulary and updates, a reminder about Medicare Part D vaccine coverage and how it is notifying impacted members and providers of changes. See the November 10 Provider Bulletin for details. Medical Drug Prior Authorization for 2024 and Preferred Product Step Therapy Information2024 UCare Medicare Plans (HMO-POS) and EssentiaCare (PPO) Formulary (List of Covered Drugs) l UCare Medicare Plans (HMO-POS) UCare Aware UCare Classic UCare Complete UCare Essentials Rx ... taking a drug on our 2024 formulary that was covered at the beginning of the year, we will not discontinue or reduce coverage of the drug during … Ucare formulary 2024, Last Updated Date. Group Medicare Formulary (List of Covered Drugs) (PDF) Group Medicare Formulary (List of Covered Drugs) Spanish (PDF) 4/1/2024. 4/1/2024. …, The National Eligibility cum Entrance Test (NEET) is an important examination for students aspiring to pursue a career in the field of medicine. With NEET 2024 on the horizon, it i..., 6 2024 UCare Medicare Plans and EssentiaCare Comprehensive Formulary − If we make such a change, you or your prescriber can ask us to make an exception and continue to cover the brand-name drug for you., 8 am – 8 pm, seven days a week. UCare's Minnesota Senior Health Options (MSHO) (HMO D-SNP) 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. Members of the UCare Minnesota Senior ..., ANTIRHEUMATIC ANTIMETABOLITES. GOLD COMPOUNDS. INTERLEUKIN-1 BLOCKERS. INTERLEUKIN-1 RECEPTOR ANTAGONIST (IL-1RA) INTERLEUKIN-1BETA BLOCKERS. INTERLEUKIN-6 RECEPTOR INHIBITORS. NONSTEROIDAL ANTI-INFLAMMATORY AGENTS (NSAIDS) PHOSPHODIESTERASE 4 (PDE4) …, 6 2024 UCare Medicare Plans and EssentiaCare Comprehensive Formulary − If we make such a change, you or your prescriber can ask us to make an exception and continue to cover the brand-name drug for you., UCare Formulary Exception Criteria (PDF) Updated 10/1/2022 Formulary Change Notice (PDF) Updated 8/1/2023. Diabetic Supply List (PDF) Updated 8/1/2023. Part B Medical Injectable Drug Authorization List (PDF) Updated 11/28/2023. UCare Medicare Part D Information EssentiaCare Part D Information UCare Advocate Part D Information. …, UCare Your Choice Plans (PPO) Formulary (List of Covered Drugs) l UCare Your Choice l UCare Your Choice Plus This formulary was updated on 01/23/2024. PLEASE READ: This document contains information about the drugs we cover in these plans. For more recent information or other questions, please contact: UCare Your Choice Plans Customer Service ... , Your guide for the rest of the year. Check out the member center to watch helpful videos, find important documents, contact customer service through your online member account and more. Thanks for being a UCare member and we look forward to helping you get the most out of your plan. Medicare member center., Preferred generic drugs. $15 copay per 30-day supply; $30 copay for up to 90-day supply. Tier 2. Non-preferred generics. $25 copay per 30-day supply; $50 copay for up to 90-day supply. Tier 3. Preferred Brand drugs. $200 copay per prescription; $25 for a 30-day supply of insulin on the formulary; $25 for a 30-day supply of select diabetes drugs., Disney Cruises 2024 includes trips on the Disney Wish, Disney Fantasy and more to the Caribbean, Mexico, Castaway Cay and more. Save money, experience more. Check out our destinati..., In today’s fast-paced world, busy families need a vehicle that can keep up with their demanding lifestyle. SUVs have long been a popular choice for families, offering ample space a..., This formulary was updated on 04/18/2024. PLEASE READ: This document contains information about the drugs we cover in these plans. For more recent information or other questions, please contact: UCare Your Choice Plans Customer Service at 612-676-6526 or 1-833-951-3183 (this call is free) For all TTY users: 612-676-6810 or 1-800-688-2534 …, UCare Medicare Plans with M Health Fairview & North Memorial | UCare Your Choice Plans 2024 Comprehensive Formularies: Formulary pages for UCare Medicare Plans, EssentiaCare, UCare Medicare with Fairview & North Memorial, UCare Advocate Plans, Upscale river cruise line AmaWaterways has announced an unusually long voyage that includes stops in 15 countries in Europe. How long is too long for a European river cruise? AmaWa..., 2024 Preferred Drug List. The .gov means it’s official. Local, state, and federal government websites often end in .gov. State of Georgia government websites and email …, Care Type: UCare’s Minnesota Senior Health Options 2024 MSHO Medical | 07.25.23 H2456 002 Issued: MM/DD/YYYY ucare.org FOR MEMBER USE – For emergency care go to the nearest hospital or call 911. Customer Service: 612-676-3200 or 1-800-203-7225, TTY: 612-676-6810 or 1-800-688-2534. UCare 24/7 Nurse Line: 1-800-942-7858 or TTY: …, Te enclosed formulary is current as of 01/23/2024. To get updated information about the drugs covered by UCare Your Choice Plans, please contact us. Our contact information …, This complete list of prescription drugs covered by your plan is current as of February 1, 2024. To get updated information about the covered drugs or if you have …, 6 2024 UCare Medicare Plans and EssentiaCare Comprehensive Formulary − If we make such a change, you or your prescriber can ask us to make an exception and continue to cover the brand-name drug for you., This formulary was updated on 04/18/2024. PLEASE READ: This document contains information about the drugs we cover in these plans. For more recent information or other questions, please contact: UCare Your Choice Plans Customer Service at 612-676-6526 or 1-833-951-3183 (this call is free) For all TTY users: 612-676-6810 or 1-800-688-2534 …, 2024 UCare Individual & Family Plans Formulary (List of Covered Drugs) l UCare Individual & Family Plans ... Te UCare formulary is a list of generic and brand drugs that are covered by this plan(s). To be covered, the drug must be on our formulary. Te most current list of covered drugs can be, 2024 UCare Individual & Family Plans Formulary (List of Covered Drugs) l UCare Individual & Family Plans l UCare Individual & Family Plans with M Health Fairview This formulary may change throughout the year. Please visit ucare.org or call UCare Customer Service for the most current information., UCare Medicare Group Plans - University of Minnesota 2024 Formulary (List of Covered Drugs) Download the complete Formulary or search the list of covered drugs below. Follow these steps to see the coverage and cost of your medication. Find out what tier your medication is. Use the drug search tool below to see whether your medication is covered ..., MinnesotaCare Tax is Changing Jan. 1, 2024. Effective Jan. 1, 2024, the amount of the tax imposed on health care providers under Minn. Stat. § 295.52 (known as the “MinnesotaCare Tax”) is changing from 1.6% to 1.8% of gross revenues. As a result, the portion of provider reimbursement that represents payment by UCare for providers ..., A list of covered drugs includes the prescription drugs covered by UCare. Te drugs on the list are selected by UCare with the help of a team of doctors and pharmacists. UCare will generally cover the drugs listed in the list of covered drugs as long as the drug is medically necessary, the ... formulary. 8 2024 Medicaid Formulary . What is a …, pharmacy network, and/or copayments/coinsurance may on change January 1, 2024, and from time to time during the year. What is the UCare Your Choice Plans Formulary? A formulary is a list of covered drugs selected by UCare Your Choice Plans in …, UCare Your Choice Plans (PPO) Formulary (List of Covered Drugs) l UCare Your Choice l UCare Your Choice Plus This formulary was updated on 01/23/2024. PLEASE READ: This document contains information about the drugs we cover in these plans. For more recent information or other questions, please contact: UCare Your Choice Plans Customer …, This formulary was updated on 04/18/2024. PLEASE READ: This document contains information about the drugs we cover in these plans. For more recent information or other questions, please contact: UCare Your Choice Plans Customer Service at 612-676-6526 or 1-833-951-3183 (this call is free) For all TTY users: 612-676-6810 or 1-800-688-2534 …, Individual & Family Plans formulary (list of covered drugs) Select your plan: ... UCare is a registered service mark of UCare Minnesota | ©2024 UCare Minnesota. All ... , 1-877-523-1515 toll-free. TTY users call 1-800-688-2534. 8 am – 8 pm, 7 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. , Prior Authorization Criteria (PDF) Updated 12/1/2023. Step Therapy Criteria (PDF) Updated 3/1/2023. UCare Formulary Exception Criteria (PDF) Updated 10/1/2022. Formulary Change Notice (PDF) Updated 8/1/2023. Diabetic Supply List (PDF) Updated 8/1/2023. Part B Medical Injectable Drug Authorization List (PDF) Updated 11/28/2023., Tier 1. Generic drugs. $0 copay or $1.55 to $4.50 copay for a 30-day supply, depending on your income and level of Medical Assistance (Medicaid) eligibility. Tier 1. Brand drugs. $0 copay or $4.60 to $11.20 copay for a 30-day supply, depending on your income and level of Medical Assistance (Medicaid) eligibility. Over-the-Counter.