Medicaid List of Covered Drugs (Formulary) 2019

Medicaid List of Covered Drugs

(Formulary) 2019

UCare Connect (SNBC)

Families and Children (Prepaid Medical Assistance Program (PMAP))

MinnesotaCare

Minnesota Senior Care Plus (MSC Plus)

UCare Connect counties: Aitkin, Anoka, Becker,

Benton, Blue Earth, Carlton, Carver, Cass,

Chippewa, Chisago, Clay, Cook, Cottonwood,

Crow Wing, Dakota, Faribault, Fillmore, Hennepin,

Houston, Isanti, Itasca, Jackson, Kandiyohi,

Kittson, Koochiching, Lac Qui Parle, Lake, Lake of

the Woods, Le Sueur, Lincoln, Lyon, Mahnomen,

Marshall, Martin, Mille Lacs, Mower, Murray,

Nicollet, Nobles, Norman, Olmsted, Otter Tail,

Pennington, Pine, Polk, Ramsey, Red Lake,

Redwood, Rice, Rock, Roseau, Scott, Sherburne,

St. Louis, Stearns, Swift, Washington, Watonwan,

Wilkin, Winona, Wright and Yellow Medicine.

Families and Children (PMAP) counties: Anoka,

Blue Earth, Carver, Chippewa, Cottonwood,

Dakota, Faribault, Fillmore, Freeborn, Hennepin,

Houston, Isanti, Jackson, Kandiyohi, Lac qui

Parle, Lake of the Woods, LeSueur, Lincoln, Lyon,

Martin, Mower, Murray, Nicollet, Nobles, Olmsted,

Ramsey, Redwood, Rice, Rock, St. Louis, Scott,

Sibley, Swift, Washington, Watonwan, Winona,

Wright, Yellow Medicine.

MinnesotaCare counties: Anoka, Big Stone, Blue

Earth, Carver, Chippewa, Cottonwood, Dakota,

Douglas, Faribault, Fillmore, Freeborn, Goodhue,

Grant, Hennepin, Houston, Isanti, Jackson,

Kanabec, Kandiyohi, Lac qui Parle, Lake of the

Woods, LeSueur, Lincoln, Lyon, McLeod, Martin,

Meeker, Morrison, Mower, Murray, Nicollet,

Nobles, Olmsted, Pipestone, Pope, Ramsey,

Redwood, Renville, Rice, Rock, St. Louis, Scott,

Sibley, Steele, Stevens, Swift, Todd, Traverse,

Wadena, Waseca, Washington, Watonwan,

Winona, Wright, Yellow Medicine.

Minnesota Senior Care Plus counties: Aitkin,

Anoka, Becker, Benton, Blue Earth, Carlton,

Carver, Cass, Chippewa, Chisago, Clay, Cook,

Cottonwood, Crow Wing, Dakota, Dodge,

Faribault, Fillmore, Freeborn, Hennepin, Houston,

Isanti, Jackson, Kandiyohi, Kittson, Koochiching,

Lac qui Parle, Lake, Lake of the Woods, Le Sueur,

Lincoln, Lyon, Mahnomen, Marshall, Martin, Mille

Lacs, Morrison, Mower, Murray, Nicollet, Nobles,

Norman, Olmsted, Otter Tail, Pennington, Pine,

Polk, Ramsey, Red Lake, Redwood, Rice, Rock,

Roseau, Scott, Sherburne, St. Louis, Stearns, Swift,

Todd, Wabasha, Wadena, Washington, Watonwan,

Winona, Wright, Yellow Medicine.

PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT

THE DRUGS WE COVER IN THIS PLAN. MEMBERS MUST USE NETWORK

PHARMACIES TO RECEIVE PRESCRIPTION DRUG BENEFITS.

UCare, 500 Stinson Blvd, Minneapolis, MN 55413

UCare Customer Service: Families and Children (PMAP), MinnesotaCare, and MSC+ Members:

612-676-3200 or 1-800-203-7225 toll free. UCare Connect: 612-676-3395 or 1-877-903-0061 toll free.

TTY: 612-676-6810 or 1-800-688-2534 toll free. Hours of operation: 8 am to 5 pm, Monday through

Friday. The call is free. For more information visit .

DHS Approved Date 10/04/2019

This list is subject to change and is not all-inclusive. The document is subject to state-specific

regulations and rules, including, but not limited to, those regarding generic substitution, controlled

substance schedules, preference for brands and mandatory generics whenever applicable. Note

to existing members: This list of covered drugs has changed since last year. Please review this

document to make sure that it still has the drugs you take. Please contact UCare Customer Service

with questions: Families and Children (PMAP), MinnesotaCare, and MSC+ Members: 612-676-3200 or

1-800-203-7225 toll free. UCare Connect: 612-676-3395 or 1-877-903-0061 toll free. TTY: 612-676-6810

or 1-800-688-2534 toll free. Hours of operation: 8 am to 5 pm, Monday through Friday. The call is

free. For more information visit .

Other drug coverage: If you have Medicare, you need to get most of your prescription drugs through

the Medicare Prescription Drug Program (Medicare Part D). You must be enrolled in a Medicare

prescription drug plan to get these services.

American Indians can continue or begin to use tribal and Indian Health Services (IHS) clinics. We will

not require prior approval or impose any conditions for you to get services at these clinics. For elders

age 65 years and older this includes Elderly Waiver (EW) services accessed through the tribe. If a

doctor or other provider in a tribal or IHS clinic refers you to a provider in our network, we will not

require you to see your heath plan Primary Care Provider (PCP) prior to the referral.

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