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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:
2023 Formulary
2022 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 Express Scripts for pharmacy benefit drugs. Providers may use ePA through ExpressPAth, Sure Scripts, CoverMyMeds or through the Electronic Health Record.

Express Scripts coverage review can be reached by phone at 1-877-558-7521 or by fax at 1-877-251-5896. Request for Medicare Prescription Drug Coverage Determination (PDF).

Care Continuum, a subsidiary of Express Scripts, reviews Medical Drug Prior Authorization requests for all Aspirus Health Plan Medicare Advantage plans.

Submit an authorization request 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 a Prior Authorization Request Form (PDF) to Care Continuum at 1-866-540-8935.
  • Call Care Continuum at 1-866-540-8289.

To request an adjustment to an existing prior authorization:

  • The authorization must be active.
  • End date extensions can be completed due to scheduling issues or health reasons (e.g., chemo delayed due to blood count) that may prevent the administration of the previously approved drug.
  • Required information for these requests:

- Reason for extension.
- Revised end date.

  • Adjustments are not approved for the reasons listed below. A new review/renewal is required.

- Additional drug is requested.
- The patient is due for a renewal.

Non-participating providers should send the Medical Injectable Drug Prior Authorization Request Form (PDF).

  • by fax to Aspirus Health Plan Clinical Services at 715-787-7319
  • or by mail to Aspirus Health Plan, Attn: Clinical Services at P.O. Box 51, Minneapolis, MN 55440-9972

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).

Pharmacy Benefit Prior Authorization
Express Scripts - Medicare
Phone: 1-877-558-7521
Fax: 1-877-251-5896

Medical Injectable Drug Prior Authorization

Care Continuum, a subsidiary of Express Scripts
Online (ePA): ExpressPAth Portal at
Phone: 1-866-540-8289.
Fax: 1-866-540-8935.

Aspirus Health Plan Clinical Services
Fax: 715-787-7319

Mail Order Contact Information
Express Scripts Mail Order Pharmacy
Phone: 1-866-544-7950
Fax: 1-800-837-0959
ePrescribing: Express Scripts Home Delivery Pharmacy