Prepaid Medical Assistance Program (PMAP) 2024 Formulary (List of Covered Prescription and Over-the-Counter Drugs)
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 |
$1 copay |
| Tier 1 Brand drugs |
$3 copay |
Note:
- No co-pays for pregnant women, children under 21, members in hospice, members residing in a nursing home for 30+ days, or adult members of a federally-recognized American Indian tribe.
- No co-pays for anti-psychotic drugs
- Copay Amount can vary based on income, call Customer Service to verify your copay.
- 90-day supply available for drugs identified on UCare’s List of Covered Drugs
More formulary information
| Documents | Last updated Date |
|---|---|
| Minnesota Health Care Programs List of Covered Drugs (Formulary) (PDF) Minnesota Health Care Programs List of Covered Drugs (Formulary) Arabic (PDF) Minnesota Health Care Programs List of Covered Drugs (Formulary) Hmong (PDF) Minnesota Health Care Programs List of Covered Drugs (Formulary) Russian (PDF) Minnesota Health Care Programs List of Covered Drugs (Formulary) Somali (PDF) Minnesota Health Care Programs List of Covered Drugs (Formulary) Spanish (PDF) Minnesota Health Care Programs List of Covered Drugs (Formulary) Vietnamese (PDF) |
12/1/2024 12/2/2024 12/2/2024 12/2/2024 12/2/2024 12/2/2024 12/2/2024 |
| Prior Authorization Criteria |
8/1/2024 |
| Diabetes Supply List (PDF) | 5/1/2024 |
| Medical Injectable Authorization List (PDF) | 11/13/2024 |
| Non-Preferred Drug Prior Authorization Criteria (PDF) | |
| Medication Therapy Management (MTM) - available at no additional cost to members with chronic health conditions who take multiple medicines. |