Medical Drug Policies

The drugs listed below have corresponding medical drug policies that contain coverage criteria for how these drugs are covered by Aspirus Health Plan when billed under the member’s medical benefit. Medical drug policies are reviewed and approved by a Pharmacy and Therapeutics Committee and are subject to change. Authorization requests should be submitted and approved prior to dispensing/administering.

Find Medical Injectable Drug Prior Authorization Resources and forms to request authorizations on our Pharmacy page. 

Medicare Policies

The coverage criteria contained in the policy may not apply to Aspirus Health Plan Medicare products if Medicare requires different coverage criteria. If Medicare requires different coverage criteria, the applicable NCD or LCD will apply. 

Some medical injectable products are dosed based on patient weight and therefore may require minor dose adjustments during the duration of the authorization. Aspirus allows for additional units to be added to the products listed in the Appendix of the Weight Based Dose Rounding Policy.