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.

Care Continuum, a subsidiary of Express Scripts, will review 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: https://www.express-path.com
• Fax the Prior Authorization Request Form (PDF) to Care Continuum at 1-866-540-8935
• Call Care Continuum at 1-866-540-8289

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