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Welcome Aspirus Medicare Advantage Providers

Medicare Advantage Plans Formulary

A Formulary outlining the covered drugs and associated limitations, along with criteria used for prior authorization is available:
2024 Formulary
2023 Formulary

Pharmacy Network – Aspirus Health Plan Medicare members have access to a preferred pharmacy network, including Aspirus pharmacies. Costs for some drugs may be less at pharmacies in this preferred network. Find pharmacies using our online pharmacy directory.


ePA is the preferred method to submit Prior Authorization requests to Navitus for pharmacy benefit drugs. Providers may use ePA through Sure ScriptsCoverMyMeds or the Electronic Health Record.

For information on Medical Injectable Drug Prior Authorization Requests, see Medical Injectable Drug Prior Authorization Resources on the Pharmacy page.


Authorization requests for pharmacy benefit drugs will not be accepted by Express Scripts after December 31, 2023.

Participating providers can submit prior authorization, authorization adjustment and pre-determination requests to Care Continuum one of the following ways:

  • Online (ePA) via the ExpressPAth Portal at Providers can submit requests, check on the status of submitted requests and submit an authorization renewal on the ExpressPAth Portal. The site also provides 24/7 access, potential for real-time approvals and email notifications once a decision is reached.
  • Fax an Authorization Request Form (PDF) to Care Continuum at 1.866.540.8935
  • Call Care Continuum at 1.866.540.8289

Non-participating and MultiPlan providers can submit prior authorization, authorization adjustment or pre-determination request to Aspirus Health Plan one of the following ways:

Providers that received a claim denial due to no authorization in place will continue to work through the provider claims appeal process using the Provider Claim Reconsideration Request Form (PDF).

The Pharmacy and Therapeutics Committee, a group of practicing physicians and pharmacists, meets up to six times per year to recommend medication inclusion or exclusion to our formularies. The Pharmacy and Therapeutics Committee evaluates drugs based on clinical evidence and efficacy (drug monographs, peer reviewed literature, compendia resources), therapeutic guidelines, medication safety and comparable data to other therapeutic alternatives. This committee reviews all new drugs approved by the FDA, new generics, new dosage forms, new indications as well as regular therapeutic class reviews and annual review of all utilization management criteria.

View the following Pharmacy and Therapeutics Committee Decisions:

March 2024 (PDF)
January 2024 (PDF)
November 2023 (PDF)
September 2023 (PDF)
June 2023 (PDF)
April 2023 (PDF)
March 2023 (PDF)
January 2023

Pharmacy Benefit Prior Authorization - Navitus Health Solutions 
*New PBM for 2024*
Phone: 1.833.837.4300
Fax: 1.855.668.8552

Medical Injectable Drug Prior Authorization 
Participating Providers Contact
Care Continuum, a subsidiary of Express Scripts:
Online (ePA): ExpressPAth Portal at
Phone: 1.866.540.8289
Fax: 1.866.540.8935

Non-Participating and MultiPlan Providers Contact 
Aspirus Health Plan Clinical Pharmacy Intake: 
Phone: 715.787.7340
Fax: 715.841.4322

Lumicera Specialty Pharmacy 
*New for 2024*
Phone: 1.855.847.3554
Fax: 1.855.847.3558

Costco Mail Order Pharmacy 
*New for 2024*
Phone: 1.800.607.6861
Fax: 1.877.258.9584
ePrescribing: Costco Mail Order Pharmacy #1348