AultCare

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Pharmacy Information

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Formulary

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The information appearing in this resource is intended to be a general guide to the costs and choices available under your prescription drug plan. The actual coverage may vary. Please refer to your specific plan benefit information for more detail. If you need to speak with a representative, please call AultCare Customer Service at 330-363-6360 or 1-800-344-8858.

Specialty Pharmacy
     BioScrip
     Mail Order Form
     Patient Brochure
     BioScrip FAQ

Aultra Pharmacy

Prescription Assistance
Click here for more information.

Step Therapy Program

Migraine Limitations
Not all plans are subject to migraine limitations.

Brand name medications that now have generic equivalents available.

*All strengths & dosage forms may not be available*

Acular opthalmic	Alphagan P 0.15%	Augmentin XR	Cellcept
Cozaar	Epi-Pen	Flomax	Hyzaar
Lamictal tabs	Mirapex	Prevacid	Prograf
Pulmicort Respules	Requip tabs	Skelaxin	Starlix
Valtrex

Medications that require Prior Authorization
• Growth Hormones
• Injectable Infertility medications
• Magnacet
• Oracea
• Solodyn
• Xolair and Synagis - if approved; this medication is covered under medical benefit not prescription benefit.

Certain medications may be covered under medical, require prior authorization and/or may have plan limitations. Please call the AultCare Service Center at 330-363-6360 or 1-800-344-8858, if you have questions or if you need a pharmacy listing.