CurrentHealthPartnersPolicy N/A

Basic HSA Preventive Drug List

A list of medications designated as HSA-eligible preventive drugs for HealthPartners members enrolled in qualifying high deductible health plans; provides which medicines are covered as preventive (with some 'MORE DETAILS' notes such as PA or QL) and guidance to check plan documents for exact coverage rules.

Policy Summary

PayerHealthPartners

PolicyBasic HSA Preventive Drug List

Policy CodePolicy N/A

Change TypeNo material change

Effective Date

Next Review Date

Key ActionProvider or pharmacy should verify member has a qualifying high deductible health plan paired with an HSA to allow copay purchase of listed preventive drugs.

POLICY UPDATE CHANGES

No material clinical or coverage changes to report.

manyListed drugs / devices

someItems with PA or QL noted

periodicList review frequency

Policy summary & scope

This HSA-paired HDHP preventive drug list enables members of qualifying high deductible health plans intended to be paired with a Health Savings Account (HSA) to purchase the listed preventive medications for a copay instead of having the cost apply to the deductible. The list was developed in accordance with federal guidance and is a subset of the full HealthPartners drug formulary and is reviewed periodically.

Use / Eligibility Notes

General program rules and notes regarding HSA preventive medications:

HSA plan requirement: Member must have a high deductible health plan intended to be paired with a Health Savings Account (HSA) to purchase medications on this preventive drug list for a copay instead of toward the deductible.
Subset of formulary: This preventive drug list is a subset of the HealthPartners drug formulary and is reviewed periodically; coverage rules may apply and are not all shown here.
PA/QL and coverage rules: Some medications on the list may require prior authorization (PA) or have quantity limits (QL) or other rules — see 'More Details' or the Pharmacy Drug List (Formulary) for complete coverage rules.
Plan documents govern: If there is a difference between this general information and plan documents, plan documents determine coverage.

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This page is informational and identifies medications that may be purchased with a copay for members enrolled in qualifying HSA-paired HDHPs. The copay option applies only when the member's plan is a high deductible health plan intended to be paired with an HSA; it does not change other coverage rules. Complete coverage requirements — such as prior authorization (PA) or quantity limits (QL) — are specified on the formulary/Pharmacy Drug List ('More Details').

Listed preventive medications (codes / products)

Listed preventive medications (by therapeutic class / drug name and strengths)mixedCovered

CARTIA XT	120 MG CAPSULE, 180 MG CAPSULE, 240 MG CAPSULE, 300 MG CAPSULE
DILT-XR	120 MG CAPSULE, 180 MG CAPSULE, 240 MG CAPSULE
diltiazem 24hr er	360 mg cap (generic for cardizem cd)
diltiazem hcl	30 mg tablet; 60 mg tablet; 90 mg tablet; 120 mg cap er 24h; 120 mg cap er deg; 120 mg cap sa 24h; 120 mg tablet; 180 mg cap er 24h; 180 mg cap er deg; 180 mg cap sa 24h; 240 mg cap er 24h; 240 mg cap er deg; 240 mg cap sa 24h; 300 mg cap er 24h; 300 mg cap sa 24h; 360 mg cap sa 24h; 420 mg cap sa 24h
TAZTIA XT	120 MG CAPSULE, 180 MG CAPSULE, 240 MG CAPSULE, 300 MG CAPSULE, 360 MG CAPSULE
TIADYLT ER	120 MG CAPSULE, 180 MG CAPSULE, 240 MG CAPSULE, 300 MG CAPSULE, 360 MG CAPSULE, 420 MG CAPSULE
verapamil hcl	40 mg tablet; 80 mg tablet; 120 mg cap24h pel; 120 mg tablet; 120 mg tablet er; 180 mg cap24h pel; 180 mg tablet er; 240 mg cap24h pel; 240 mg tablet er; 360 mg cap24h pel
warfarin sodium	1 mg, 2 mg, 2.5 mg, 3 mg, 4 mg, 5 mg, 6 mg, 7.5 mg, 10 mg tablets
citalopram hydrobromide	10 mg tablet, 20 mg tablet, 40 mg tablet
escitalopram oxalate	5 mg tablet, 10 mg tablet, 20 mg tablet

1–10 of 110

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Actions for providers and pharmacies

Documentation Required

Confirm HSA-eligible plan enrollment

Provider or pharmacy should verify member has a qualifying high deductible health plan paired with an HSA to allow copay purchase of listed preventive drugs.

Prior Authorization

Prior authorization / Quantity limits

Some medications on the list have 'MORE DETAILS' indicating prior authorization (PA) or quantity limits (QL); providers must follow pharmacy formulary rules and submit PA when required. Consult the Pharmacy Drug List (Formulary) for complete coverage rules and specifics on PA/QL.

Billing Rule

Check plan documents for coverage differences

If there is a discrepancy between this list and plan documents, billing must follow the plan documents; verify specific coverage and copay rules before dispensing.

Providers and pharmacies should verify that the member is enrolled in a qualifying HSA-paired high deductible health plan before dispensing from this list, and should check the formulary 'More Details' flags for any PA or QL requirements. When there is any discrepancy, billing and coverage must follow the member's plan documents, so confirm whether a given purchase is processed as a copay or as subject to the deductible per plan rules.