AME Group Elect Rx Drug Formulary June 2021 Personal Importation Program (90-day supplies) Brand Medications Available Through Elect Rx
Elect Rx Customer Service: 1-855-353-2879 Open 8:30AM to 4:30PM M-F Physician Fax: 1-833-353-2879
All drugs on this list are available to traditional/PPO plan members at a $0 co-pay Drugs Highlighted in Blue are available to H.S.A. plan members at a $0 co-pay Please call Customer Service if you do not see your Drug listed! Drug Name Actemra Advair Diskus - PA/G Advair Inhaler Afinitor*- PA/G Aklief Cream Alecensa** Alomide Alphagan P - PA/G Alrex Alvesco Anoro Ellipta Apidra Aptiom Arnuity Ellipta Asacol HD - PA/G Asmanex Astagraf XL Atripla* Atrovent Aubagio* Avonex Azelex Azilect - PA/G Azopt Banzel* Baqsimi Basagler Benlysta Benzaclin - PA/G Bepreve Besivance Betoptic S Biktarvy* Binosto Blephamide Bosulif* Breo Ellipta Brilinta Bydureon Bystolic Cambia Canasa - PA/G Cardura XL Cimzia Ciprodex Ear Drops
Drug Name Combigan Combipatch Combivent Complera* Copaxone Corlanor Cortifoam Cosentyx Cosopt PF Creon Crinone Gel Cuprimine - PA/G Daliresp Daraprim Delstrigo Denavir Cream Descovy* Dexilant Dipentum Divigel Dovato Duaklir Pressair Duavee Dulera Duobrii Dymista - PA/G Edarbi Edarbyclor Edecrin Edurant Eliquis Elmiron Emcyt Emtriva Enablex - PA/G Enbrel* Entocort - PA/G Entresto Envarsus Epiduo Forte Epivir HBV - PA/G Esbriet Estring Estrogel Gel Eucrisa Ointment
Drug Name Evotaz Exelon Patches - PA/G Fareston - PA/G Farxiga Ferriprox Fetzima FIASP Flovent Flovent HFA Inhaler Fosamax D Frova - PA/G Genotropin Genvoya* Gilenya* Gilotrif* Gleostine Glyxambi Grastek Humalog Humatrope Humira* Humulin Ibrance* Imbruvica* Incruse Ellipta Inlyta* Intelence Intrarosa Invega - PA/G Invirase Invokamet Invokana Iressa* Isentress* Jadenu - PA/G Jakafi* Janumet Janumet XR Januvia Jardiance Jentadueto Jublia Topical Solution Juluca* Kaletra*- PA/G Kazano - PA/G
Drug Name Kisqali** Kombiglyze XR Kynmobi Lacrisert Lantus Latuda Lenvima** Levemir Lexiva*- PA/G Lialda - PA/G Linzess Locoid Lipocream - PA/G Lonsurf Lotemax Eye Drops- PA/G Lupron Depot Lynparza** Mayzent - 0.25MG* Mayzent - 2MG* Mekinst - 0.5MG* Mekinst - 2MG* Mestinon 180MG - PA/G Migranal - PA/G Mirvaso Motegrity Multaq Myleran Myrbetriq Nasonex - PA/G Natazia Nesina - PA/G Neulasta Neupogen Neupro Nevanac Nexavar** Nexium Packets Nitrolingual - PA/G Nocdurna Norditropin Noritate Novolin Novolog Nubeqa Nucala Nuvaring - PA/G
Drug Name Odefsey Ofev 100MG* Ofev150MG** Olumiant* Omnaris Nasal Spray Ongentys Onglyza Opsumit* Oracea - PA/G Oralair Orencia Orilissa Orthovisc Otezla* Oxytrol Ozempic Pazeo Pentasa Pifeltro Plaquenil - PA/G Pradaxa Premarin Prempro Prestalia Prevacid Solutab - PA/G Prezcobix Prezista* Promacta* Pulmicort Qtern Qvar Inhaler Qvar Redihaler Rebif Relpax - PA/G Renagel - PA/G Restasis Rexulti Ridaura Rinvoq Rybelsus Sancuso Santyl Ointment Saphris Savaysa Saxenda
Drug Name Segluromet Selzentry* Serevent Seroquel XR - PA/G Silenor - PA/G Simbrinza Simponi* Skyrizi Soliqua Soolantra - PA/G Soriatane - PA/G Spiriva Spiriva Respimat Sprycel* Steglatro Steglujan Stelara* Stiolto Stivarga Stribild* Striverdi Sustiva - PA/G Sutent - 12.5MG* Sutent - 25MG** Sutent - 50MG* Symbicort Inhaler- PA/G Symtuza* Synarel Synjardy Taclonex - PA/G Tafinlar* Taltz* Tarceva*- PA/G Tasigna* Tasmar - PA/G Tazorac Cream - PA/G Tazorac Gel Tecfidera*- PA/G Tekturna - PA/G Tivicay* Toujeo Solostar Toviaz Tradjenta Transderm-Scop - PA/G Travatan Z - PA/G
PA/G - Prior Authorization Required by TrueScripts - Generic Available - TrueScripts Needs to Check Price of Generic *This medication will only be dispensed as a one month supply due to the high cost of this medication. **This medication will only be dispensed as a one month supply due to the high cost of this medication & must be paid in full before shipping.
Drug Name Trelegy Ellipta Tremfya* Tresiba Tribenzor - PA/G Trintellix Triumeq* Trizivir - PA/G Trulicity Truvada* Tudorza Pressair Tykerb Uceris - PA/G Velphoro Veltassa Vemlidy Verzenio** Viberzi Victoza Viibryd Vimpat Viracept Votrient* Vraylar Vyzulta Xadago Xarelto Xeljanz Xeljanz XR Xeloda - PA/G Xenazine - PA/G Xenical Xerese Cream Xifaxan - 200MG Xifaxan - 550MG Xigduo XR Xiidra Xtandi Zelapar Ziana Gel - PA/G Zolinza** Zomig Spr Zortress*- PA/G Zovirax Cream - PA/G Zyclara - PA/G