Drug list (formulary)

We want our members to have access to the safest, most effective drugs at a price they can manage. To be included in the drug list, medicines generally must:

• Be FDA-approved
• Have proven safe and effective in published studies
• Have better outcomes than existing drugs, or
• Cost less and have the same outcomes as existing drugs

Decisions about what’s on the drug list are made by a committee of doctors and pharmacists.

If your medicine is not on the list, or if it displays with “NF,” your medicine is non-formulary. This either means that the medicine is not covered by your insurance, or it’s covered but may cost more to fill. Call Member Services to learn which situation applies to you.

In the formulary search results screen, there is a link called “Find Alternative Drugs.” Review this list with your doctor and see if there is one that works for you.

The vast majority of prescriptions written for our members are on the drug list. But we know there are rare cases when there isn't a drug on the formulary that works for you. In these cases, your doctor can request an exception.

Our team of pharmacists review each request based on criteria including:

• Medicines on the drug list that you’ve already tried
• Evidence that the medicine you want to take is effective
• Medical necessity

If the pharmacy team approves your exception, your medicine will be covered even if it’s not on the drug list. Requests generally receive a response within one business day.

Download formulary exception form

There are a few drugs that are never approved for an exception. Pharmacists and doctors compiled this list based on availability of suitable alternatives, outcomes and cost effectiveness.

See excluded drug list

Yes, your doctor can initiate an appeal by calling the Pharmacy team at 952-883-5813. The new request should include any relevant information that wasn’t included in the original request. A medical director will review the appeal within three business days, or you can request an expedited review.

MED means that a medical policy applies to the drug. Your doctor usually administers these drugs in a healthcare setting. The policy specifies the conditions for which a doctor can prescribe these drugs. It also outlines any other rules that apply to administering them. You can see coverage rules that apply on the coverage criteria page.

See coverage criteria

A committee of doctors and pharmacists reviews the drug list on a regular basis. The team looks at the latest research, FDA approvals and market conditions. Their goal is always to make sure members can access the most effective drugs at a cost they can manage.

See details about recent changes to the drug list below:

The HealthPartners Pharmacy and Therapeutics Committee develops and maintains its formulary based on the following principles. They reflect 6 goals: safety, timeliness, effectiveness, equity, efficiency and patient-centeredness. We make formulary decisions by thoughtfully weighting these often‐competing principles.

The following principles are prioritized in descending order:

1. Proven effectiveness – Our primary consideration will is degree to which a medication produces clinically desirable effects. We base our assessment on scientific evidence including peer-reviewed medical literature, pharmacoeconomic studies and outcomes research. We also consider standards of practice such as treatment protocols and evidence‐based practice guidelines (e.g. those from the Institute for Clinical Systems Improvement (ICSI)). Randomized, controlled trials are weighted most heavily, followed by non‐randomized trials, case reports and medical opinion.
2. Maximizing safety – We compare the potential for errors with other treatments. Our goal is to minimize the potential for errors caused by product characteristics such as name, dosage form, and packaging.
3. Optimizing pharmacoeconomics – We consider the overall value of a drug or therapy in relation to existing treatments. We assess both direct and indirect pharmacy and medical costs in relation to outcomes. Preference is given to agents that optimize the use of financial and service resources over the largest potential population.
4. Emphasis on products essential to health.
5. Significant improvements in patient convenience, adherence, and satisfaction – We review more favorably products with significant improvements in these areas. Examples include easier dosing, variety of dosage forms, better taste, ability to crush or divide doses and more flexible storage requirements.
6. The formulary supports ICSI protocols and other locally adopted treatment algorithms.
7. Long term stability of formulary decisions – we try to minimize formulary changes to support continuity of care.

The formulary is a guideline for the vast majority of patients.

1. Utilization management programs such as prior authorization, step‐edits, MD‐edits, quantity limits, and age limits are applied to promote appropriate utilization.
2. A formulary exception process is readily available, easy to use, and timely. Appeal rights and how to appeal is clearly outlined in all adverse determination letter.
3. A transition of care policy is available to assist members transitioning to HealthPartners.