2024 Q3 Drug formulary change notification

• 07/31/2024

Key points

• Hennepin Health is making several changes to its drug formulary for Q3 2024. 
• The changes apply to all Hennepin Health members.
• The updated full drug formulary is available online on Hennepin Health's Forms/documents page.
  • A printed copy can be obtained by calling Provider Services at 612-596-1036 (select option #2).

Background

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

Effective Aug. 1, 2024, these medications were added and utilization management (UM) requirements are listed if applicable:

Alrex, QL = 5ml/30 days
Bepreve, QL = 5ml/30 days
Genotropin cartridge 
Genotropin syringe
Mesalamine (Generic of Canasa), QL = 1 supp/day
Olopatadine OTC (0.10%; 0.20%)
Omega-3 acid ethyl esters (Generic of Lovaza)
Testim

Effective Aug. 1, 2024, these medications were removed:

Alocril
Beconase AQ
Benzaclin (Topical)
Benzaclin Gel Pump
Bystolic
Canasa 
Claravis Cap 
Clindagel
Clindamycin/Benzoyl Peroxide (Acanya) with pump
Colestgid Granules
Coreg CR
Corzide
Dapagliflozin
Delzicol
Detrol LA
Duexis
Dutoprol
Elestat
Emadine
Fesoterodine
Fortesta
Gelnique
Kadian
Lastacaft
Levatol
Lidoderm
Memantine tablet dose pack (AG)
Mesalamine (Generic of Lialda)
Natesto
Olopatadine (nasal)
Pantanse
Razadyne ER
Razadyne tablet
Vimovo
Xipere

Resources

• Hennepin Health Customer Services: 612-596-1036 (select option #2) 
• Hennepin Health website: www.hennepinhealth.org