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Important information for Hennepin Health SNBC plan members who joined April 1, 2025.

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2025 Q4 Drug Formulary Change Notification

  • 10/15/2025

Hennepin Health is making a change to its drug formulary for Q4 2025. This change applies 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 Oct. 15, 2025, these medications were added as preferred drugs to the formulary:

• Voriconazole tablet
• Paxlovid tab dose pack
• Bisoprolol HCTZ
• Coreg CR
• Nebivolo
• Propranolol/HCTZ
• Trulicity
• Eucrisa
• Exelon (transderm)
• Fesoterodine ER (oral)
• Myrbetriq (oral)
• Albuterol HFA (generic AND authorized generic of Proair HFA)
• Albuterol HFA (generic of Proventil HFA)

 

Effective Oct. 15, 2025, these medications were removed as preferred drugs on the formulary and require a prior authorization:

• Corgard
• Pindolol
• Boniva
• Etidronate disodium
• Augmentin XR
• Keflex (oral)
• Tudorza Pressair
• Symjepi
• Bydureon Bcise
• Byetta pens
• Lovaza
• Exelon capsules
• Namenda XR
• Coumadin
• Ditropan XL (oral)
• Enablex (oral)
• Adalat CC
• Calan
• Calan SR
• Jesduvroq
• Ciprofloxacin ER (oral)

 

Effective Oct. 15, 2025, these medications have prior authorization requirements:

• Quinapril
• Arikayce
• Diflucan tablet
• Oravig
• Vfend tablet
• Vfend suspension
• Voriconazole suspension
• Naftifine cream
• Bystolic
• Binosto
• Tezruly
• Augmentin 125 suspension
• Augmentin ES- 600 suspension
• Umeclidinium- vilanterol Ellipta
• Neffy spray
• Exenatide pen
• Ebglyss
• Nemluvio
• Zoryve foam
• Tryngolza
• Toviaz
• Detrol LA (oral)
• Mirabegron ER (oral)
• Lyumjev Tempo Pen U-100

 

Effective Oct. 15, 2025, prior authorizations were removed from these medications:

• Bisoprolol HCTZ
• Coreg CR
• Nebivolo
• Propranolol/HCTZ
• Trulicity
• Exelon (transderm)
• Fesoterodine ER (oral)
• Albuterol HFA (generic AND authorized generic of Proair HFA)
• Albuterol HFA (generic of Proventil HFA)

 

Effective Oct. 15, 2025, these medications have quantity limits (QL):

• Voriconazole tablet
• Paxlovid tab dose pack
• Coreg CR
• Tudorza Pressair
• Symjepi
• Exelon (Transderm)
• Fesoterodine ER (oral)
• Myrbetriq (oral)
• Albuterol HFA (generic AND authorized generic of Proair HFA)
• Albuterol HFA (generic of Proventil HFA)
• Amphetamine/dextroamphetamine ER cap

 

Resources

• Hennepin Health Customer Services: 612-596-1036 (press 2)
• List of Covered Drugs (Formulary) effective 10/15/2025 (PDF)
• Hennepin Health website: www.hennepinhealth.org
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