Generic Incentive Program
This program assists members with transitioning to a generic equivalent for certain medications when clinically appropriate. An incentive may reduce member cost share. This cost-share adjustment is based on brand name manufacturer assistance programs. Please call AultCare Customer Service at 330-363-6360 or 1-800-344-8858 (TTY 711) for any questions regarding this program.
| Product Name Extension | Route of Administration | GENERIC ALTERNATIVE |
| AUBAGIO | OR - ORAL | TERIFLUNOMIDE TAB |
| AFFINTOR | OR - ORAL | EVEROLIMUS TAB |
| ALKERAN | OR - ORAL | MELPHALAN TAB |
| AMPYRA | OR - ORAL | DALFAMPRIDINE TAB ER 12HR 10 MG |
| APOKYN | SC - SUBCUTANEOUS | APOMORPHINE HCL SOLN CARTRIDGE |
| BUPHENYL | OR - ORAL | SOD PHENYLBUTYRATE |
| CARBAGLU | OR - ORAL | CARGLUMIC ACID SOLUBLE TAB |
| CELLCEPT | OR - ORAL | MYCOPHENOLATE MOFETIL CAP TABS |
| COPAXONE | SC - SUBCUTANEOUS | GLATIRAMER ACETATE SOLN PREFILLED SYRINGE |
| DARAPRIM | OR - ORAL | PYRIMETHAMINE TAB 25 MG |
| ESBRIET | OR - ORAL | PIRFENIDONE |
| GILENYA | OR - ORAL | FINGOLIMOD HCL CAP 0.5 MG (BASE EQUIV) |
| GLEEVEC | OR - ORAL | IMATINIB |
| HEPSERA | OR - ORAL | ADEFOVIR DIPIVOXIL TAB 10 MG |
| LETAIRIS | OR - ORAL | AMBRISENTAN TAB |
| MYFORTIC | OR - ORAL | MYCOPHENOLATE SODIUM TAB DR 180 MG (MYCOPHENOLIC ACID EQUIV) |
| NEORAL | OR - ORAL | CYCLOSPORINE MODIFIED CAP |
| NEXAVAR | OR - ORAL | SORAFENIB TOSYLATE TAB |
| NILANDRON | OR - ORAL | NILUTAMIDE TAB |
| NORTHERA | OR - ORAL | DROXIDOPA CAP |
| ORFADIN | OR - ORAL | NITISINONE CAP |
| PROGRAF | OR - ORAL | TACROLIMUS CAP |
| RAPAMUNE | OR - ORAL | SIROLIMUS ORAL |
| REVLIMID | OR - ORAL | LENALIDOMIDE CAPS |
| SABRIL | OR - ORAL | VIGABATRIN |
| SAMSCA | OR - ORAL | TOLVAPTAN TAB |
| SANDIMMUNE | OR - ORAL | CYCLOSPORINE CAP |
| SUTENT | OR - ORAL | SUNITINIB |
| TARCEVA | OR - ORAL | ERLOTINIB TAB |
| TARGRETIN | EX - EXTERNAL | BEXAROTENE GEL 1% |
| TECFIDERA | OR - ORAL | DIMETHYL FUMURATE CAP |
| TEMODAR | OR - ORAL | TEMOZOLOMIDE |
| TOBI | IH - INHALATION | TOBRAMYCIN INH |
| TRACLEER | OR - ORAL | BOSENTAN |
| XELODA | OR - ORAL | CAPECITABINE TAB |
| XENAZINE | OR - ORAL | TETRABENAZINE TAB |
| ZORTRESS | OR - ORAL | EVEROLIMUS TAB |
This list of medications is subject to change without notice. Clinical programs, including step therapy, quantity limits and prior authorization may exist for the above medications, which may affect your coverage.