Drug formulary changes for 2020 Q3

• 7/17/2020
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PROVIDERS AFFECTED 

All providers

KEY POINTS

• We have made several changes to the drug formulary for Q3 2020.
• The changes apply to all Hennepin Health members.
• The updated full drug formulary is available online. A printed copy can be obtained by calling Provider Services at 612-596-1036 (select the provider services option).

BACKGROUND

We have made several changes to the drug formulary. These changes apply 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 the provider services option).

The 2020 Q3 drug formulary changes are as follows:

Effective 7/1/20, these medications were added:

• Albuterol HFA inhaler (Generic Proventil HFA inhaler); quantity limit 2 inhalers/30 days
• Ciclopirox suspension; quantity limit 30 gm/30 days
• Ciclopirox cream; quantity limit 30 gm/30 days
• Ciclopirox solution; quantity limit 7 ml/30 days
• Clotrimazole Betamethasone cream; quantity limit 30 gm/30 days
• Clotrimazole cream; quantity limit 30 gm/30 days
• Econazole cream
• Ketoconazole shampoo
• Miconazole cream OTC
• Miconazole powder OTC
• Nystatin cream
• Nystatin ointment
• Nystatin powder
• Nystatin triamcinolone cream
• Terbinafine cream OTC
• Tolnaftate cream OTC

Effective 7/1/20, these medications were removed:

• Cromolyn nebulizer solution

RESOURCES

• Hennepin Health Member Services: 612-596-1036 (select the provider services option)
• 2020 Medicaid list of covered drugs (Formulary) – effective 7/1/20 (PDF)
• Hennepin Health website: hennepinhealth.org