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2025 UCare Medicare and EssentiaCare Formulary

Welcome

We cover both brand name drugs and generic drugs. Generic drugs have the same active-ingredient formula as a brand name drug. Generic drugs usually cost less than brand name drugs and are rated by the Food and Drug Administration (FDA) to be as safe and effective as brand name drugs.

What is a Formulary?

A formulary is a list of covered drugs which represents the prescription therapies believed to be a necessary part of a quality treatment program. We will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at a network pharmacy, and other plan rules are followed. For more information on how to fill your prescriptions, please review your Evidence of Coverage.

How to Search For Drugs

  • Use the alphabetical list to search by the first letter of your medication.
  • Search by typing part of the generic (chemical) and brand (trade) names.
  • Search by selecting the therapeutic class of the medication you are looking for.
  • Important Message About What You Pay for Vaccines - Our plan covers most Part D vaccines at no cost to you, even if you haven’t paid your deductible. Call Member Services for more information.
  • Important Message About What You Pay for Insulin - You won’t pay more than $35 for a one-month supply of each insulin product covered by our plan, no matter what cost-sharing tier it’s on, even if you haven’t paid your deductible.

Legend

TIERING
  • 1
    - Preferred Generics
  • 2
    - Generics
  • 3
    - Preferred Brands
  • 4
    - Non-Preferred Drugs
  • 5
    - Specialty
  • Part-B
    - Part B Covered
  • NF
    - Non-Formulary
Requirements
  • QL
    - Quantity limit: There are limits to the amount of drug covered per fill
  • PA³
    - Prior Authorization required to determine coverage under Part B or Part D
  • PA
    - Prior authorization is required before we’ll cover the drug
  • PA²
    - Prior Authorization required if you haven’t taken the drug before
  • C
    - Covid-19 treatments covered at $0 (no cost)
  • VAC
    - Part D Adult Vaccine covered at $0 (no cost)
  • INS
    - Insulins with a $35 copay per one-month supply
  • VAC-AGE
    - Part D Adult Vaccine covered at $0 (no cost) for ages 19 – 45
  • MFG
    - Drug coverage is limited to certain manufacturers
  • NDS
    - Non-Extended Day Supply: Drugs limited to a 30-day supply per fill
  • LA
    - Limited Access: Drugs that are only available at certain pharmacies
† Denotes brand name drug, otherwise generic drug
Brand Names
generic names
Formulary Id: 392 ver. 10
Last Updated: 3/1/2025
Effective 03/2025