Drug list (formulary)
A drug list – also called a formulary – lists your health plan’s preferred medicines. You’ll usually pay less when you choose a drug that’s on the list. Our search tools make it easy to see if your prescriptions are on the list. You can also find alternatives that may save you money.
How to search the drug list
Your drug list depends on which insurance plan you have. So, to get the most complete and accurate information we recommend logging in to your account.
Search the drug list without logging in
If you're shopping for insurance, or don't have an account, you can still search your drug list. You'll need to know which list your health plan uses. You can find this information in your plan booklet or by calling Member Services.
Here are the most common formularies:
- PreferredRx – most employer plans with over 100 members
- GenericsAdvantageRx – individual plans and most employer plans with fewer than 100 members
- Minnesota Health Care Programs (Medicaid)
Supplemental drug lists
Your plan may cover one or more types of drugs that are not listed on the formulary. If your plan includes this coverage, you can find details below. Call Member Services to learn what your plan covers.
- Diabetes drug list – blood glucose testing products and other diabetes supplies
- Specialty drug list – medicines for chronic and complex diseases
- Growth hormone list
- Infertility treatments
- Hepatitis C treatment
Preventive drug benefit
Some HSA plans let you buy prescription drugs at a copay, even if you haven't reached your deductible. If your plan has this benefit, you can see which drugs qualify.
Frequently asked questions
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.
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.
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.
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:
- Formulary Update, January 2019 Commercial and State Programs
- Formulary Update, January 2019 Medicare
- Formulary Update, April 2019 Commercial and State Programs
- Formulary Update, April 2019 Medicare
- Formulary Update, July 2019 Commercial
- Formulary Update, July 2019 Medicare
- Formulary Update, October 2019 Commercial
- Formulary Update, October 2019 Medicare
- Formulary Update, October 2019 State Programs
- January: Commercial and State Programs
- Formulary Update, April 2018, Commercial and State Programs
- Formulary Update, April 2018 Medicare
- Formulary Update, July 2018, Commercial and State Programs
- Formulary Update, July 2018 Medicare
- Formulary Update, October 2018 Commercial and State Programs
- Formulary Update, October 2018 Medicare
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:
- 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.
- 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.
- 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.
- Emphasis on products essential to health.
- 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.
- The formulary supports ICSI protocols and other locally adopted treatment algorithms.
- 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.
- Utilization management programs such as prior authorization, step‐edits, MD‐edits, quantity limits, and age limits are applied to promote appropriate utilization.
- 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.
- A transition of care policy is available to assist members transitioning to HealthPartners.