UCare's MSHO 2025 List of Covered Drugs (Formulary)
Download the complete Formulary or search the list of covered drugs below.
Find out what tier your medication is
Use the drug search tool below to see whether your medication is covered and what tier it is
Find out how much your medication costs
Use this tier table to see how much your medication costs
| Tier | 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 | $0 copay |
Important Message About What You Pay for Vaccines - Our plan covers most Part D vaccines at no cost to you. Call Customer Service for more information.
More formulary information
| Document | Last Updated Date |
| UCare's MSHO and UCare Connect + Medicare List of Covered Drugs (Formulary) (PDF) | 10/1/2024 |
| Prior Authorization Criteria (PDF) | 1/1/2025 |
| UCare Formulary Exception Criteria (PDF) | 4/1/2024 |
| Formulary Change Notice (PDF) | Coming soon |
| Diabetic Supplies List (PDF) | 5/1/2024 |
| Non-Preferred CGM and Testing Criteria (PDF) | 10/1/2024 |
| Part B Medical Injectable Drug Authorization List (PDF) | 11/13/2024 |
| MSHO Part D Information | |
| UCare Connect + Medicare Part D Information |