Pharmacy Benefits
For Hennepin Healthcare Members
On This Page
Pharmacy benefits
Your Hennepin Healthcare plan includes coverage of prescription drugs. Learn more about how your pharmacy benefits work using the resources below.
Sign in to your account
Your secure member site, to view your specific pharmacy benefits and find:
Pharmacy locations
You can fill your prescription at any Hennepin Healthcare Pharmacy location for the lowest copayment. You can also fill your prescription at a retail pharmacy in our large pharmacy network, but you’ll have a higher copay.
Want to transfer your prescription to a Hennepin Healthcare Pharmacy? Just call or stop by a Hennepin Healthcare Pharmacy to request a prescription. The pharmacy team will call the other pharmacy and transfer the prescription that same day.
|
Pharmacy locations |
||
|---|---|---|
| Brooklyn Park Clinic Pharmacy 7650 Zane Ave. N. Brooklyn Park MN 55443 612-873-8800 |
Clinic & Specialty Center Pharmacy 715 S. Eighth St., Level 1 |
Hennepin Healthcare Red Lower Pharmacy 730 Eighth St., RL 120 |
|
North Loop Pharmacy 800 Washington Ave. N., Suite 190 |
Richfield Clinic Pharmacy 790 W. 66th St. Richfield, MN 55423 612-352-5810 |
Shapiro Pharmacy 914 S. Eighth St. |
|
St. Anthony Village Clinic Pharmacy 2714 Highway 88 |
Specialty Services Pharmacy 716 South 7th St. Minneapolis, MN 55415 612-873-2070 |
Whittier Pharmacy 2810 Nicollet Ave. |
Drug list
Covered drugs are shown on the Drug List. This list includes both brand-name and generic drugs, and is reviewed and updated regularly by a group of independent physicians and pharmacists. Your doctor can use this list to choose the medications that are right for you, while helping you get a good value. The drug list is divided into three groups, which determine your share of the costs (generic, preferred brand and non-preferred brand). Generic drugs have the lowest copayment or coinsurance.
93-day refill options
You can pick up a three-month supply of medication at one time from a Hennepin Healthcare pharmacy for your best benefit at twice your retail copay or at certain other retail pharmacies for three times your retail copay.
To find a pharmacy near you, sign in to your secure member site. Use the Price a Medication tool and select a
93-day supply.
Specialty drugs
Some medications are considered specialty drugs. They’re used to treat certain complex health conditions. Specialty drugs tend to be expensive and may need special handling. The Specialty Drug List is divided into two groups, preferred and non-preferred. Preferred specialty drugs have the lowest copay or coinsurance. To see your share of the costs and a list of medications that are considered specialty drugs, sign in to your secure member site.
You'll find most specialty drug prescriptions through a Hennepin Healthcare Pharmacy. Call your Hennepin Healthcare Pharmacy for more information.
If you need to fill a new specialty drug:
- Check the Specialty Drug List, which shows all medications we consider specialty drugs.
- Your plan may not cover all of the drugs on the specialty drug list, so check your coverage document on your secure member site, or call the Customer Service number on the back of your Medica ID card for your specific benefits.
- Once you've verified your benefits, have your prescription filled through a Hennepin Healthcare Pharmacy.
Mail order
With mail order, you can have ongoing medications mailed directly to your home from a Hennepin Healthcare pharmacy. Contact your preferred Hennepin Healthcare pharmacy and let pharmacy staff know you are interested in mail order services. Pharmacy staff will coordinate all prescriptions needed, to avoid multiple shipments and potential delays. When all medications have been filled by the pharmacy, Pharmacy Mail Order Services will contact patients to coordinate delivery. It's that easy!
FAQs
A brand-name drug is protected by a patent for a set amount of time. That means only one manufacturer can make it during that time. Once the patent expires, it’s often possible to get generic versions of the drug.
Generic drugs have the same active ingredients as their brand-name counterparts. They also must meet the same quality standards as brand-name drugs, but they’re usually less expensive.
Both brand-name and generic drugs are regulated by the Food and Drug Administration (FDA).
Generic drugs have the same active ingredients as their brand-name counterparts. They also must meet the same quality standards as brand-name drugs, but they’re usually less expensive.
Both brand-name and generic drugs are regulated by the Food and Drug Administration (FDA).
Yes. A team of physicians and pharmacists regularly reviews new and existing drugs to be sure the list continues to meet our members’ and providers’ needs. Drugs may be added to the list at any time during the year. But we work to limit removing drugs to no more than twice a year.
A generic medication could replace a brand-name version on the list. If you’re taking a brand name that’s no longer available, we’ll send you a letter to explain this change.
A generic medication could replace a brand-name version on the list. If you’re taking a brand name that’s no longer available, we’ll send you a letter to explain this change.
A quantity limit is a maximum amount of a drug that can be filled during a specific time period. For example, 60 tablets per month. Drugs that have a quantity limit are noted on the Drug List.
Specialty drugs are used to treat certain complex health problems. They tend to be expensive and may need special handling and monitoring. For most specialty medications, you'll use a Hennepin Healthcare Pharmacy.
If you need to fill a new specialty drug:
1. Check the Specialty Drug List, which shows all medications we consider specialty drugs.
2. Your plan may not cover all of the drugs on the Specialty Drug List, so check your coverage document on your secure member site, or call the Customer Service number on the back of your Medica ID card for your specific benefits.
3. Once you've verified your benefits, have your prescription filled through a Hennepin Healthcare Pharmacy.
Call your Hennepin Healthcare Pharmacy for more information.
If you need to fill a new specialty drug:
1. Check the Specialty Drug List, which shows all medications we consider specialty drugs.
2. Your plan may not cover all of the drugs on the Specialty Drug List, so check your coverage document on your secure member site, or call the Customer Service number on the back of your Medica ID card for your specific benefits.
3. Once you've verified your benefits, have your prescription filled through a Hennepin Healthcare Pharmacy.
Call your Hennepin Healthcare Pharmacy for more information.
Step Therapy is a program that uses cost-effective prescription drugs as first-line treatment when appropriate. The program is used for conditions where there are many treatment options available. Drugs that require Step Therapy are noted on the Drug List.
In Step Therapy, you try the Step 1 preferred drug or drugs first. Step 1 drugs are cost-efficient and effective options. If the Step 1 drug isn't effective, you can try the Step 2 drug. In some cases, you may need to try more than one Step 1 drug before trying a Step 2 drug.
Step Therapy applies to all members, regardless of their plan type. That means if you don't try the Step 1 drug or drugs first, then a Step 2 drug won't be covered. Your doctor can request an exception to this process.
In Step Therapy, you try the Step 1 preferred drug or drugs first. Step 1 drugs are cost-efficient and effective options. If the Step 1 drug isn't effective, you can try the Step 2 drug. In some cases, you may need to try more than one Step 1 drug before trying a Step 2 drug.
Step Therapy applies to all members, regardless of their plan type. That means if you don't try the Step 1 drug or drugs first, then a Step 2 drug won't be covered. Your doctor can request an exception to this process.
Prior Authorization is approval we give for coverage of a specific medication. Medications that need Prior Authorization are noted on the Drug List with a "PA" next to the drug name. As a provider in the Medica network, your doctor will know how to request Prior Authorization.
Your doctor can request an exception to the drug list by faxing a completed Exception Request Form.
Your doctor should provide all the requested information, including which medications have been tried and didn't work — e.g., dosage information and reason for failure, side effects, lack of effectiveness, and the like.
Your doctor should provide all the requested information, including which medications have been tried and didn't work — e.g., dosage information and reason for failure, side effects, lack of effectiveness, and the like.
Yes. If your exception request is denied, we’ll send you a letter explaining your right to appeal, along with how to do an appeal.