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We have many Medicare Part D resources available to help you understand the prescription drug coverage that comes with your HealthPartners Medicare plan.

Our Medicare formulary (drug list)

A formulary is a list of medicines covered by an insurance plan. You may also hear this referred to as a drug list. You can search the drug list to check if your medicines are covered by our plans.

Search the 2021 drug lists online

Individual HealthPartners Medicare plans

All individual HealthPartners Medicare plans use Formulary I.

Search the 2021 Medicare Formulary I drug list

Please note that if you have a HealthPartners MSHO plan, the search tool gives results for Medicare Part D covered drugs only. See the MSHO Drug List below for a complete list of all MSHO covered drugs. The MSHO Drug List also includes drugs covered by Medical Assistance (Medicaid).

Group retirees

You may have Formulary I, or you may have Formulary II. If you don’t know which one applies to your plan, contact Member Services.

Download or print the 2021 drug lists

You can also download or print the entire 2021 Medicare drug list for your plan:

How to find a pharmacy

We contract with more than 63,000 pharmacies. Want to see if your pharmacy is in our network?

Find a pharmacy

Drug list FAQs

If you have questions about your medications or how your Medicare Part D coverage works, we’re here to help.

Each Medicare drug plan has its own list of covered drugs. This is called a formulary (drug list).

Our formulary lists the drugs covered by our Medicare plans. You can search the list by the name of your medication.

When we make our drug list, our team of pharmacists and doctors reviews information on new medicines covered by the U.S. Food and Drug Administration. Our experts compare it to the meds that are already on the list. The goal is to make sure our drug list has the safest and most effective medicines.

When you look at the drug list, you may notice that our drug plan places drugs into different tiers.

Drugs in each tier have a different cost. Knowing what tier your drug is in – together with looking at your plan’s benefits – can help you predict how much that drug will cost. Drugs in lower tiers generally cost less than drugs in higher tiers:

  • Tier 1: Preferred generic drugs
  • Tier 2: Generic drugs
  • Tier 3: Preferred brand drugs and select insulin drugs
  • Tier 4: Non-preferred drugs
  • Tier 5: Specialty drugs

Minnesota Senior Health Options (MSHO) has one tier, but your copay depends on whether it’s a generic or a brand-name drug.

Both prescription medicine and over-the-counter medicine can have brand-name and generic versions. Generic and brand-name drugs use the same active ingredients, and they have the same dosage, strength, instructions and use. In fact, the FDA requires generic drugs to be as effective as brand-name drugs.

The biggest differences between generic and brand-name drugs are what they look like and what they cost. Trademark laws require generic drugs to look different than brand-name versions. Generic drugs also typically cost less than the brand-name versions.

Specialty drugs tend to be high-cost drugs. They are often self-injected and treat complex or rare conditions.

It depends. If your plan has a deductible, you’ll need to pay the full cost of each prescription that applies toward the deductible until the deductible is met. After that, HealthPartners will share the cost of your prescription drugs.

The tier your drug is in and your plan’s benefits determine the amount you’ll pay. Keep in mind that not all tiers may apply toward the deductible. That means that for some prescriptions, your HealthPartners plan may share the cost of drugs immediately.

If you qualify, Medicare could pay up to 100% of your drug costs through the Extra Help program. This could include monthly prescription drug premiums, annual deductibles and coinsurance.

Finally, the amount you pay can depend on where you fill your prescriptions. Cost can be different at a network pharmacy, an out-of-network pharmacy or a mail order pharmacy.

Learn more about pharmacy options or find a pharmacy

Sometimes. Some covered drugs may have extra requirements or limits, including:

  • Prior authorization – We may require prior authorization for certain drugs, even if they’re on the drug list. This means that you’ll need to get approval from HealthPartners before you fill your prescription. If you don’t get prior approval, your drug may not be covered.
    See prior authorization criteria
  • Quantity limits – With some drugs, there are limits on the amount of drugs we cover. For example, this limit may be in the form of only covering a 30-day supply with each refill. There may also be limits on the number of tablets for a specific prescription that we’ll cover in one day.
  • Step therapy – In some situations, you may be required to try another drug before we cover the drug you’re requesting. For example, if Drug A and Drug B both treat your medical condition, HealthPartners may not cover Drug B until you try Drug A first. If Drug A doesn’t work for you, HealthPartners would then cover Drug B.
    See step therapy criteria

Yes. There are thousands of drugs on the market, and new ones are added all the time. To make sure you get the highest quality, safest and most cost-effective drugs, we continually update our drug list.

If we plan to remove drugs from the list or plan to add restrictions, we’ll let you know at least 60 days in advance.

If the FDA deems a drug to be unsafe, or if the drug manufacturer removes the drug from the market, we take it off our drug list immediately. If this happens, we’ll let you know, and we’ll work with you to find a replacement.

If you can’t find your drug on the list, call Member Services to confirm it’s not covered. Member Services always has the most up-to-date information.

If we no longer cover your drug, please talk with your doctor about other options. You can ask Member Services to send you a printed drug list, or you can print the drug list yourself. Then, bring the drug list to your doctor and ask them to prescribe you a similar drug HealthPartners covers. If nothing is available, you or your prescriber can ask for an exception.

Formulary change notices

You can find required formulary change notices here.

You can ask HealthPartners to make an exception to our coverage rules. There are several types of exceptions you can ask us to make, including:

  • Covering your drug if it isn’t on the drug list
  • Waiving our coverage limits on your drug
  • Asking us to cover your drug under a different cost-sharing tier

If the request is approved, your medicine will be covered, even if it’s not on the drug list. In most situations, we review and respond to requests in the way we receive them.

Learn more about Medicare appeals and grievances

If you’re not seeing the answer to your question, we can help. Call Member Services or review your plan details to learn more.

Info on the Medicare Extra Help program

People with limited incomes may be able to get extra help paying their Part D prescription drug costs through the Medicare Extra Help program. (You may also hear this called a low-income subsidy, or LIS.)

If you qualify, Medicare could pay up to 75% or more of your drug costs, including monthly prescription drug premiums, annual deductibles and coinsurance.

Do I qualify for the Medicare Extra Help program?

To find out whether you qualify for a low-income subsidy, you can do one of the following:

After you know how much help you qualify for, use this chart to view your subsidized monthly premiums (this does not include any Medicare Part B premium you may have to pay):

Your level of extra help Journey Pace Journey Stride Journey Dash Journey Steady Robin Birch Robin Maple MSHO
100% $0 $13.00 $53.00 $98.00 $0 $0 $0
75% $0 $22.50 $62.50 $107.50 $0 $6.50 $0
50% $0 $32.00 $72.00 $117.00 $0 $13.00 $0
25% $0 $41.50 $81.50 $126.50 $0 $19.50 $0

Our transitional medication policy

HealthPartners will provide transitional medications to:

  • New enrollees to HealthPartners Medicare Part D plans as of January 1, following the Annual Enrollment Period (AEP).
  • Newly eligible Medicare beneficiaries from other coverage.
  • Individuals who switch from one plan to another after January 1.
  • Enrollees residing in long-term care (LTC) facilities.
  • Enrollees residing in LTC facilities who have changes in level of care. For example, those entering an LTC facility or being discharged from a hospital. In this situation, early refills will be granted due to changes in an enrollee’s level of care (when appropriate).
  • Continuing enrollees affected by negative formulary changes from one contract year to the next.

One-time, temporary supply of non-formulary Part D drugs

HealthPartners will provide a one-time, temporary supply of non-formulary Part D drugs in order to accommodate the immediate needs of an enrollee. Non-formulary drugs include:

  • Part D drugs that are not on the HealthPartners formulary.
  • Part D drugs that are on HealthPartners formulary but – under HealthPartners utilization management rules – require prior authorization, require step therapy or have an approved quantity limit lower than the enrollee’s current dose.

One-time, temporary one month fill at retail setting

Our transition policy provides a one-time, temporary fill of at least one month's supply of medication at the retail setting (unless the enrollee presents a prescription written for less than one month's supply, in which case HealthPartners will allow multiple fills to provide up to a total of one month of medication) anytime during the first 90 days of enrollment in a plan. This 90-day period begins on the enrollee’s effective date of coverage, or, for continuing enrollees, the first 90 days of the contract year.

One month allows the plan and/or enrollee sufficient time to work with the prescriber to either switch to a therapeutically equivalent medication on the HealthPartners drug list or complete an exception request to maintain the coverage of the non-formulary drug based upon medical necessity reasons.

Cost sharing for one-time transitions

The cost sharing for one-time transitions will never exceed an enrollee’s maximum copayment or coinsurance amounts (including an enrollee’s low-income subsidy amounts, if eligible). Cost sharing will be based upon the applicable tier of the non-formulary drug labeled, meaning brand drugs will process under the brand copay, when appropriate.

Procedures following a transition fill

HealthPartners will send written notice to an enrollee within three business days of a transition fill, indicating:

  • An explanation of the temporary nature of the transition supply an enrollee has received.
  • Instructions for working with HealthPartners and the enrollee’s prescriber to identify therapeutic alternatives, when available and appropriate.
  • An explanation of the enrollee’s right to request a formulary exception.
  • Description of the procedures for requesting a formulary exception.

Legal information

Last updated October 2020

H2422_000402 Approved

H2462 H4882_000402 Accepted

 
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