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Aspirus Health Plan Medicare plans

  • Essential Rx (PPO)

More formulary documents

Document Last Updated Date
Drug search tool (formulary with coverage limitations and drug requirements)
10/1/2025
Formulary (List of Covered Drugs) (PDF) 10/1/2025
Prior Authorization Criteria (PDF) 10/1/2025
Aspirus Formulary Exception Criteria (PDF) 4/28/2025
Formulary Change Notice (PDF) Coming soon
Part B Medical Injectable Drug Authorization List (PDF) 8/12/2025
Diabetic Supplies List (PDF) 5/1/2024
Non-Preferred CGM and Testing Criteria (PDF) 10/1/2024
Part D Information