AultCare Formulary

This formulary listing is intended for the use and application to those plans subject to the AultCare Formulary.

This formulary does not apply to those plans not governed by the formulary. Refer to your "AultCare Prescription Drug Program" brochure to see if the formulary applies to your plan.

AultCare 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.

If there are additional questions, please call the AultCare Service Center at (800) 344-8858.

Click here for the 2017 AultCare Formulary

If your ID card says Marketplace Formulary, only specific drugs in each therapeutic class are covered. Medications not listed on our formulary are not covered under the plans. Click here to learn about non formulary coverage determinations.

Please click below:

Click here for the 2017 Marketplace Formulary
Click here for the 2017 Marketplace Formulary - Numbered by Tier