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Frequently asked questions for Hennepin Health SNBC plan members who joined April 1, 2025.

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Drug formulary changes for Q4 2023 - update

  • 12/28/2023

We have made several changes to the drug formulary. These changes apply to Hennepin Health-PMAP, Hennepin Health-MinnesotaCare and Hennepin Health-SNBC members. Members who are directly impacted will receive notification of the changes. The updated full drug formulary is available on the website. A printed copy can be obtained by calling Provider Services at 612-596-1036 (press 2).

Effective 10/15/2023, these medications were added:
COVID-19 Vaccine INJ 6M-11Y (MODERNA)
COVID-19 Vaccine INJ 5-11Y (PFIZER)
COVID-19 Vaccine 6M-4Y (PFIZER)
COMIRNATY INJ
SPIKEVAX INJ

Effective 11/01/2023, these UM requirements of prior authorizations (PA) and/or quantity limits (QL) were added:

Metronidazole gel 1%; QL = 60 gm/30days
Metronidazole gel 0.75%; QL = 45gm/30 days
Glipizide/metformin tab; PA

Effective 11/01/2023, these UM requirements of prior authorizations (PA) and/or quantity limits (QL) were removed:
Janumet tab; removed QL
Glyburide/metformin tab; remove PA required for members age 65 or older and replace with PA required for all ages
Jentadueto tab; remove PA required for members age 65 or older and replace with PA required for all ages
Kombiglyze XR tab; remove PA required for members age 65 or older and replace with PA required for all ages
Saxagliptin/metformin er tab; remove PA required for members age 65 or older and replace with PA required for all ages

Effective 12/01/2023, these medications were removed:
Cimetidine soln 300 mg/5ml
CIMITIDINE SOLN 300 mg/5ml

Effective 12/01/2023, these UM requirements of prior authorizations (PA) and/or quantity limits (QL) were added:
Famotidine susp; PA for 9  years and older; QL = 50ml/30 days

RESOURCES

  • Hennepin Health Member Services: 612-596-1036 (press 2) 
  • 2024 Medicaid list of covered drugs (Formulary) – effective 1/01/2024 (PDF)
  • Hennepin Health website: hennepinhealth.org  

 

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