Frequently asked questions for Hennepin Health SNBC plan members who joined April 1, 2025.
December 28, 2023
2024 Q1 drug formulary change notification.
All providers
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 01/01/2024, these medications were removed: Contrave Nicotrol inhaler Nicotrol nasal spray Votrient tab Effective 01/01/2024, these medications and UM requirements of prior authorization (PA) were added: Pazonpanib hcl tab Effective 01/01/2024, this medication was added: Methadone soln 5mg/5ml Effective 01/01/2024, these medications and UM requirements of quantity limits (QL) were added: Paxlovid tab 150-100mg, QL = 20 tabs/fill Paxlovid tab 300-100mg, QL = 30 tabs/fill Lagevrio cap 200 mg, QL = 40 caps/fill Effective 01/01/2024, the 90DS indicator was added to these medications: Acarbose tab Acetazolamide ER cap Acetazolamide tab Amantadine cap Azathioprine tab Benazepril/hydrochlorothiazide tab Bisoprolol tap Calcitriol cap Carbamazepine chew tab Carbidopa/Levodopa ER tab Carbidopa/Levodopa tab Dapsone tab Diclofenac potassium tab Diltiazem ER cap Dorzolamide/Timolol Opth soln Eplerenone tab 25 mg, 50 mg Fenofibrate cap 67 mg, 134 mg, 200 mg Flecainide tab Fluoxetine soln Fluphenazine tab Flurbiprofen tab Fluvoxamine tab Haloperidol tab Hydroxychloroquine tab Hyoscyamine sulfate CR tab Indapamide tab Isosorbide dinitrate tab Labetalol tab Lacosamide tab Lactulose soln Lamivudine soln Leflunomide tab Levetiracetam ER tab, Roweepra ER tab Liothyronine tab Losartan/hydrochlorothiazide tab Lurasidone HCL tab 20 mg, 40mg, 60 mg Mefloquine tab Norethindrone tab Oxcarbazepine tab Phenytoin cap, Phenytoin ext cap Phospha 250 neutral tab Progesterone cap Propranolol ER cap Ranolazine tab Sulindac tab Timolol Maleate Ophth soln Tolterodine tab Topiramate tab Torsemide tab Trazodone tab Valproic acid cap Valsartan tab Valsartan/hydrochlorothiazide tab Ziprasidone cap 20 mg, 40 mg Effective 01/01/2024, the 90DS indicator was removed from these medications: Amlodipine/Valsartan tab Cimetidine tab Donepezil tab Doxepin cap Enalapril tab Estradiol tab Fludrocortisone tab Gylburide/Metformin tab Guanfacine IR tab Levetiracetam tab, roweepra tab Metolazone tab Mirtazapine ODT Nateglinide tab Nifedipine ER tab Nitroglycerin SL tab Pentoxifylline ER tab Potassium chloride ER cap Potassium chloride ER tab 10 meq Potassium chloride Micro tab Prasugrel tab Pravastatin tab Prazosin cap Primidone tab Propranolol tab Quetiapine XR tab Sildenafil tab 20 mg Sulfasalazine tab (AZULFIDINE equiv) Tamoxifen tab Verapamil ER tab