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

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2024 Q4 Drug Formulary Change Notification

  • 12/01/2024

Hennepin Health is making several changes to its drug formulary for Q4 2024. 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 the website. A printed copy can be obtained by calling Provider Services at 612-596-1036 (select option 2). 

Effective 12/01/2024, these medications were added as preferred drugs on the PDL:
Diclegis
Aimovig
Baqsimi
Glucagon Emergency Kit
Restatis
Restatis Multidose
Xiidra
Cefixime capsule

Effective 12/01/2024, these medications require a prior authorization:
(Notes: * means these medications were removed as preferred drugs on the PDL; ** means these medications are non-preferred on the PDL)

Atorvaliq**
Bonjesta**
Cequa**
Cyclosporine (ophthalmic)**
Dexlansprazole capsule**
Dhivy**
Diltiazem tablet ER (LA)**
Doxylamine succinate/Vitamin B6**
Entadfi**
Ertaczo**
Eysuvis**
Glucagon Emergency Kit**
Gvoke pen**
Gvoke syringe**
Gvoke vial**
Isradipine**
Jesduvroq**
Katerzia**
Konvomep**
Levamlodipine maleate**
Libervant**
Miebo**
Mircera**
Nicardipine**
Norliqva**
Oxistat lotion**
Penciclovir**
Retacrit**
Tamiflu capsule**
Tamiflu suspension**
Tasmar**
Tyrvaya**
Verapamil**
Verapamil 360 mg capsule**
Verkazia**
Vevye**
Zavzpret**
Zegalogue autoinjector**
Zegalogue syringe**
Zepbound**
Diastat*
Bensal HP*
Exelderm cream*
Exelderm solution*
Naftifine cream*
Oxistat cream*
Penlac*
Sulconazole nitrate cream*
Sulconazole nitrate solution*
Mirapex*
Sinemet CR*
Verelan*
Pravachol*
Aciphex Sprinkle*
Sarafem*
Pip butoxide/Pyrethrins/Permethrin kit OTC*
Sklice*
Zovirax capsule*
Zovirax suspension*
Zovirax tablet*
Suprax capsule*
Glyset*
Avandia*
Zyflo CR*
E.E.S. 400 tablet*
Zontivity*
Megace*
Megace ES*

Effective 12/01/2024, Quantity Limits (QL) were added to these medications:
Diastat Rectal Gel, QL = 2 inj/fill
Diclegis Tab, QL – 4 tabs/day
Baqsimi Nasal Powder, QL = 2 inhalations/fill
Glucagon Inj Kit (amphastar equiv), QL = 2 inj/fill
Restasis Ophth Emulsion, QL = 60 vials/30 days
Restasis Multi-Dose, QL = 5.5ml/30 days (5.5ml = 1 bottle)
Xiidra Ophth Soln, QL = 60 vials/30 days
Tamiflu cap 45 mg, 75 mg, QL = 10 caps/fill
Tamiflu cap 30 mg, QL = 20 caps/fill
Tamiflu Susp 6MG/ML, QL = 120ml/fill, 2 fills/year

Resources

  • Hennepin Health Customer Services: 612-596-1036 (select option 2) 
  • Forms/documents | Hennepin Health
  • Hennepin Health website: hennepinhealth.org
 
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