The formulary is a list of covered drugs selected by the health plan and a team of health care providers. This group represents the prescription therapies believed to be a necessary part of a quality treatment program. The plan generally covers these drugs as long as the drug is medically necessary and the prescription is filled at a network pharmacy. For more information on how to fill your prescriptions, please refer to your Evidence of Coverage.
Minnesota Statute 151.21 states that if a prescription is given for a medication without indication that the prescription is to be dispensed as communicated, pharmacists will dispense a less expensive generically equivalent drug that is safely interchangeable with the prescribed drug. The pharmacist shall disclose the substitution to the purchaser and dispense the generic drug.
The 2017 Medicaid formulary applies only to members who do not have coverage with another insurance plan such as Medicare Part D.
Group numbers: 7000, 7100, 7200, 7800, 7900, 8280, 8380, 9080, 9280, 9380, 9480, 9980
The 2017 wrap formulary (PDF) applies only to members who have Medicare coverage with another insurance plan.
Group numbers: 8290, 8390, 9090, 9290, 9390, 9490, 9990
If a patient needs assistance with obtaining his/her prescription(s), there are several pharmacies within Hennepin County that offer home-delivery prescription services (PDF).
To request coverage of a medication that requires prior authorization or is considered non-formulary, providers need to complete and submit a prior authorization form (PDF) to Hennepin Health. Hennepin Health will only accept a prior authorization request received by secure fax at 612-321-3712 or sent by secure email at HH.Pharmacy.PA@hennepin.us. Please note, it is up to each prescriber to ensure that a prior authorization is sent via encrypted email. If you do not have email encryption or are unsure how to use it, please send your request to the secure fax number provided. Your request, along with your patient’s medical history, will be reviewed and used to make a determination regarding whether the plan will pay for the requested medication.