The Medicaid List of Covered Drugs (Formulary) applies to members who are on a Hennepin Health plan, Families and Children (PMAP), MinnesotaCare or Special Needs BasicCare (SNBC) in Hennepin County.
Medicaid list of covered drugs (Formulary) – effective 3/4/2021 (PDF)
List of covered drugs for SNBC members with Medicare coverage (Formulary) - effective 7/1/2020 (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.
To appeal the denial of a prescription, providers need to complete and submit a drug reconsideration request form (PDF) to Hennepin Health. This request should be submitted with any previous and new information for a second-level review.