2026 Q3 Drug Formulary Change Notification

• 06/04/2026

Hennepin Health is making a change to its drug formulary for Q3 2026. This change applies to Hennepin Health-PMAP, Hennepin Health-MNCare and Hennepin Health-SNBC members. Changes are effective either July 1, 2026 or August 4, 2026. Members who are directly impacted will receive notification of the changes. The updated full drug formulary is available on the Hennepin Health website. A printed copy can be obtained by calling Provider Services at 612-596-1036 (select option 2). 

Effective July 1, 2026, this medication will require a Prior Authorization

• Methyldopa tab

Effective July 1, 2026, these medications will have a quantity limit (QL)

• Celecoxib cap, QL = 2 caps/day, only one strength allowed per month. Note: this medication will no longer be able to be filled as a 90 day supply. After July 1, this drug may continue to be filled up to a 30-day supply.
• Zomig Spray, QL updated, QL = 1 box/fill,1 fill/30 days

Effective August 4, 2026, these medications were added as preferred drugs on the formulary

• Brivaracetam tablet
• Apokyn
• Dalfampridine ER
• Eliquis sprinkle
• Eliquis tablet suspension

Effective August 4, 2026, these medications were removed as preferred drugs on the formulary

• Zoryve foam
• Freestyle Libre 14 Day Reader
• Gengraf
• Sandimmune solution

Effective August 4, 2026, these medications will have a quantity limit

• Brivaracetam tablet, QL = 2 tabs/day 
• Dalfampridine ER, QL = 2 tabs/tay
• Eliquis Sprinkle Cap, QL = 70 cap/28 days
• Eliquis Tab for Oral Susp Pack 4 x 0.5 MG(2 MG), QL = 20 tabs/day
• Eliquis Tab for Oral Susp 0.5 MG, QL = 5 tabs/day
• Eliquis Tab for Oral Susp Pack 3 x 0.5 MG (1.5MG), QL = 15 tabs/day
• Accu-Chek Guide Meter, QL = 1 meter/365 days
• Accu-Chek Guide Me Meter, QL = 1 meter/365 days
• Contour Next EZ Meter Kit, QL = 1 meter/365 days
• Contour Next One Meter, QL = 1 meter/365 days
• Contour Plus Blue Meter, QL = 1 meter/365 days
• Dexcom G7 Receiver, QL = 1 receiver/year
• Freestyle Libre 2 Receiver, QL = 1 receiver/year
• Freestyle Libre 3 Receiver, QL = 1 receiver/year
• Dexcom G7 Sensor (15 Day), QL = 2 sensors/30 days
• Dexcom G6 Sensor, QL = 3 sensors/28 days
• Dexcom G6 Transmitter, QL = 1 transmitter/90 days
• Dexcom G7 Sensor, QL = 3 sensors/28 days
• Freestyle Libre 14 Day Sensor, QL = 2 sensors/28 days
• Freestyle Libre 2 Sensor, QL = 2 sensors/30 days
• Freestyle Libre 3 Sensor, QL = 2 sensors/30 days
• Freestyle Libre 2 Plus Sensor, QL = 2 sensors/30 days
• Freestyle Libre 3 Plus Sensor, QL = 3 sensors/30 days
• Contour Next One Meter, QL = 1 meter/365days

Effective August 4, 2026, these medications will require a prior authorization Memantine/donepezil ER capsule 

• Zunveyl
• Olmesartan/amlodipine/HCTZ
• Arbli suspension
• Valsartan solution
• Oxcarbazepine ER
• Subvenite suspension
• Topiramate solution
• Apokyn
• Apomorphine
• Crexont capsule ER
• Onapgo
• Anzupgo cream
• Zoryve 0.05% cream
• Zoryve foam 
• Cladribine
• Tyruko
• Zurnai
• Rivaroxaban
• Rivaroxaban suspension
• Freestyle Libre 14 Day Reader
• Kirsty vial
• Kirsty pen
• Gengraf
• Gengraf Oral Solution
• Sandimmune solution

RESOURCES  

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