Pharmacy Info

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Select the logo of Your Pharmacy Network (Located on your I.D. Card).

If there is no pharmacy logo on your I.D. card use the PDM Information below.

PDM INFORMATION

Resources
  • 2017 Formulary
  • 2018 Formulary

    • Aultra offers our members an open formulary design (which means that the health plan may cover the costs of drugs that are not on the formulary list). Therefore, tier exceptions are not applicable. For example, a higher tier (Non Preferred) medication may not be requested at a lower tier (Preferred) co-pay.


Mail Order Pharmacy
Free Meter Program

Items of Interest

Brand name medications that now have generic equivalents available.
* All strengths & dosage forms may not be available (Generic name in parenthesis) *
Abilify
(Aripiprazole)		 Exforge
(Amlodipine/Valsartan)		 Intuniv
(Guanfacine)		 Generess FE
(Norethindrone/Eth Estradiol/FE)
Nexium
(Esomeprazole)		 Protopic Ointment
(Tacrolimus ointment)		 Vivelle-DOT
(Estradiol patch)		 Tarka
(Trandolapril/Verapamil)
Colcrys
(Colchicine)		 Mirapex ER 0.75 mg, 1.5 mg
(Pramipexole ER)		 Valcyte
(Valganciclovir)		 Celebrex
(Celecoxib)
Actonel 150 mg
(Risedronate)		 Baraclude
(Entecavir)		 Vigamox ophth soln
(Moxafloxacin ophth soln)		 Patanase spray
(Olopatadine spray)
Stromectol
(Ivermectin)


Note: Certain medications may be covered under medical, require prior authorization and/or may have plan limitations. Please call the Aultra Service Center at 330-363-2050 or 1-855-270-8497, if you have questions or if you need a pharmacy listing.
Last updated: 4/27/2018 12:00:00 AM
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