2027 Q1 Drug Formulary Change Notification

• 10/30/2026

Hennepin Health is making changes to its drug formulary effective Jan. 1, 2027. 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 Jan. 1, 2027, these medications are added to the formulary:  

• Dextromethorphan cap 
• Hydroxyzine hcl syrup (only covered for members age 8 or younger) 
• Cyproheptadine syrup (only covered for members age 8 or younger) 

Effective Jan. 1, 2027, these medications have Quantity Limit (QL) adjustments:  

• Naproxen sodium tab: remove QL 
• Piroxicam cap: QL = 1/cap/day; remove only one strength allowed per month 
• Pregabalin cap: QL = 3 caps/day, only one strength allowed per month 
• Sirolimus Tab 2 mg: QL = 3 tabs/day 
• Vitamin B12 inj (cyanocobalamin): remove QL 
• Vitamin D Cap 50,000 units (high potency): remove QL 
• Atorvastatin tab 10 mg, 20 mg, 40 mg, 80 mg (Lipitor equiv): QL = 1 tab/day  
• Rosuvastatin tab 5mg, 10 mg, 20 mg, 40 mg (CRESTOR equiv) QL = 1/tab/day  
• Aripiprazole tab: QL =1 tab/day 
• Aripiprazole tab 2mg, 5mg, 10 mg, 15 mg, 20 mg, 30 mg (ABILIFY equiv): QL = 1/tab/day (delete GPI-14 set up to fall under GIP-12) 

Effective Jan. 1, 2027, these medications are available for a 90-day supply:

• Diclofenac sodium EC tab
• Nitroglycerin oint 
• Carbamazepine ER tab 
• Levetiracetam ER tab, roweepre ER tab 
• Ethosuximide syrup 
• Trazodone tab 
• Cholestyramine powder pack 
• Carbidopa/ Levodopa Tab 
• Lurasidone HCL tab 80 mg; QL - = 1 tab/day 
• Lurasidone HCL tab 120 mg; QL= 1 tab/day 
• Ziprasidone cap 60 mg; QL=3 caps/day 
• Ziprasidone cap 80 mg; QL = 2 caps/day 
• Risperidone soln 
• Haloperidol tab 
• Quetiapine XR tab 
• Chlorpromazine tab 
• Ritonavir tab 
• Mycophenolate mofetil tab 
• Nebivolol hcl tab 
• Propranolol tab 
• Nifedipine cap 
• Ursodiol tab 
• Brimonidine tartrate ophth soln 0.1% 
• Propylthiouracil tab 
• Fesoterodine fumarate ER tab; QL=1 tab/day 
  
  

Resources 

• Hennepin Health Customer Services: 612-596-1036 (press 2)  
• Forms / formulary | Hennepin Health 
• Hennepin Health website: https://www.hennepinhealth.org/