2025 Q1 Drug Formulary Change Notification

  • 02/28/2025

Hennepin Health has 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 Hennepin Health website. A printed copy can be obtained by calling Provider Services at 612-596-1036 (select option 2).

Effective March 1, 2025, these medications have utilization management (UM) requirements:

  • tranexamic acid tab: removed prior authorization, added quantity limit = 30 tabs/30 days
  • estradiol valerate 10 mg/ml inj: added quantity limit = 5 ml/30 days
  • estradiol valerate 20 mg/ml inj: added quantity limit = 5 ml/30 days
  • fluocinolone otic oil (DERMOTIC equiv): removed prior authorization; added quantity limit = 1 bottle/30 days
  • tramadol tab 100 mg (ULTRAM equiv): added prior authorization and quantity limit = 4 tabs/day
  • lamotrigine ER tab; added quantity limit = 2 tabs/day

Resources:

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