Some drugs or injections require prior authorization. To request coverage for a medication that requires prior authorization or is considered non-formulary, providers must complete and submit the prescription drug prior authorization form.
Prescription drug prior authorization form (PDF)
Send the form:
Additional form: Prescription drug reconsideration request (PDF)
Some health care services given to our members require prior authorization. Providers are responsible to verify eligibility and benefits before providing services to members.
Our prior authorization list outlines which services require prior authorization or notification to Hennepin Health.
Prior authorization list (PDF)
Medicaid list of covered drugs (Formulary) – effective 10/1/2021 (PDF)
List of covered drugs for SNBC members with Medicare coverage (Formulary) - effective 9/1/2021 (PDF)