2026 Q4 Drug Formulary Change Notification

09/01/2026

Hennepin Health is making changes to its drug formulary effective Nov. 3, 2026. 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 Hennepin Health website. A printed copy can be obtained by calling Provider Services at 612-596-1036 (select option 2).

Effective Nov. 3, 2026, these medications are added to the formulary:

Fetzima Cap
Fetzima Titration Pack
Trintelix
Vilazodone
Qulipta
Sumatriptan (nasal)
Sumatriptan kit (subcutane.)
Sumatriptan disp syringe (subcutane.)
Sumatriptan vial (subcutane.)
Ziprasidone (intramusc)
Starjemza syringe (subcutane.)
Starjemza vial (subcutane.)
Tofacitnib
Tofacitnib ER
Tyenne vial (intravenous)
Tyenne pen (subcutane.)
Tyenne syringe (subcutane.)
Mounjaro (subcutane.)
Ozempic tablet (oral)
Nucala autoinjector (subcutane.)
Nucula syringe (subcutane.)
Nucala vial (subcutane.)
Diclofenac potassium tablet
Atenolol/Chlorthalidone (oral)
Albuterol HFA (inhalation)
Cefpodoxime tablet
Prucalopride tablet
Foundayo tablet
Wegovy HD (subcutane.)
Wegovy tablet
Zepbound pen (subcutane.)

Effective Nov. 3, 2026, these medications require a prior authorization:

Desvenlafaxine ER
Viibryd
Exxua tab ER
Exxua tab ER Titration Pk
Raldesy solution
Escitalopram capsule
Brekiya Autoinjector
Imitrex kit
Symbravo tablet
Zomig (nasal)
Bysanti
Ziprasidone (intramusc)
Pyzchiva vial (subcutane.)
Pyzchiva syringe (subcutane.)
Pyzchiva vial (intravenous)
Starjemza syringe (subcutane.)
Starjemza vial (subcutane.)
Starjemza vial (intravenous)
Tofacitnib
Tofacitnib ER
Steqeyma syringe (subcutane.)
Steqeyma vial (intravenous)
Tyenne vial (intravenous)
Tyenne pen (subcutane.)
Xeljanz
Yesintek syringe (subcutane.)
Yesintek vial (subcutane.)
Icotyde
Ustekinumag-aauz syringe (subcutane.)
Janumet XR
Mounjaro (subcutane.)
Ozempic tablet (oral)
Dapaglifozin/saxagliptin
Sitgliptin/metformin ER (Zituvimet XR)
Sitagliptin phosphate (Januvia)
Sitagliptin phos/metformin (Janumet)
Nucala autoinjector (subcutane.)
Nucula syringe (subcutane.)
Nucula vial (subcutane.)
Exdensur syringe (subcutane.)
Coxanto
Dolobid
Orudis
Vyscoxa suspension
Zybic oral suspension
Vivanse capsule
Arynta solution
Lisdexamfetamine chewable tablet
Cefixime tablet
Saxenda
Foundayo tablet
Wegovy HD (subcutane.)
Wegovy tablet
Zepbound pen (subcutane.)
Liraglutide (subcutane.) (Saxenda)
Zepbound Kwikpen (subcutane.)
Ozempic inj
Victoza inj

Effective Nov. 3, 2026, these medications have a quantity limit (QL):

Fetzima Cap; QL = 1 cap/day; only one strength allowed per month
Fetzima Titration Pack; QL = 1 pack/365
Trintelix; QL = 1/tab/day
Vilazodone; for 10 mg and 20 mg QL = 0.5 tab/day; for 40 mg QL = 1 tab/day and only one strength allowed per month for 10, 20, and 40 mg
Qulipta; QL = 1 tab/day
Sumatriptan (nasal); QL = 3 boxes/30 days
Sumatriptan kit (subcutane.); QL = 4 kits/30 days
Sumatriptan disp syringe (subcutane.); QL = 4 kits/30 days
Sumatriptan vial (subcutane.); QL = 8 vials/30 days
Albuterol HFA (inhalation); QL = 2 inhalers/30 days
Prucalopride tablet: QL = 1 tab/day

Effective Nov. 3, 2026, these medications are discontinued:

Imitrex vial (product discontinued)
Linagliptin/metformin (product discontinued since Nov. 2025)
Lidocaine cream 4% (MONY Y GPI has been discontinued) (others still active)

Resources

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