Hennepin Health is making several changes to its drug formulary for Q4 2024. 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 option 2). Effective 12/01/2024, these medications were added as preferred drugs on the PDL: Diclegis Aimovig Baqsimi Glucagon Emergency Kit Restatis Restatis Multidose Xiidra Cefixime capsule Effective 12/01/2024, these medications require a prior authorization: (Notes: * means these medications were removed as preferred drugs on the PDL; ** means these medications are non-preferred on the PDL)
Atorvaliq** Bonjesta** Cequa** Cyclosporine (ophthalmic)** Dexlansprazole capsule** Dhivy** Diltiazem tablet ER (LA)** Doxylamine succinate/Vitamin B6** Entadfi** Ertaczo** Eysuvis** Glucagon Emergency Kit** Gvoke pen** Gvoke syringe** Gvoke vial** Isradipine** Jesduvroq** Katerzia** Konvomep** Levamlodipine maleate** Libervant** Miebo** Mircera** Nicardipine** Norliqva** Oxistat lotion** Penciclovir** Retacrit** Tamiflu capsule** Tamiflu suspension** Tasmar** Tyrvaya** Verapamil** Verapamil 360 mg capsule** Verkazia** Vevye** Zavzpret** Zegalogue autoinjector** Zegalogue syringe** Zepbound** Diastat* Bensal HP* Exelderm cream* Exelderm solution* Naftifine cream* Oxistat cream* Penlac* Sulconazole nitrate cream* Sulconazole nitrate solution* Mirapex* Sinemet CR* Verelan* Pravachol* Aciphex Sprinkle* Sarafem* Pip butoxide/Pyrethrins/Permethrin kit OTC* Sklice* Zovirax capsule* Zovirax suspension* Zovirax tablet* Suprax capsule* Glyset* Avandia* Zyflo CR* E.E.S. 400 tablet* Zontivity* Megace* Megace ES* Effective 12/01/2024, Quantity Limits (QL) were added to these medications: Diastat Rectal Gel, QL = 2 inj/fill Diclegis Tab, QL – 4 tabs/day Baqsimi Nasal Powder, QL = 2 inhalations/fill Glucagon Inj Kit (amphastar equiv), QL = 2 inj/fill Restasis Ophth Emulsion, QL = 60 vials/30 days Restasis Multi-Dose, QL = 5.5ml/30 days (5.5ml = 1 bottle) Xiidra Ophth Soln, QL = 60 vials/30 days Tamiflu cap 45 mg, 75 mg, QL = 10 caps/fill Tamiflu cap 30 mg, QL = 20 caps/fill Tamiflu Susp 6MG/ML, QL = 120ml/fill, 2 fills/year