text: This medication is nonpreferred and is subject to the Minnesota Department of Human Services Non‑Preferred Drug Prior Authorization Criteria. NOTE: Many products reference HealthPartners or MHCP product‑specific prior authorization/coverage criteria documents — see the HealthPartners public coverage‑criteria search page or the linked PDF for drug‑specific requirements.
{"text":"Product‑specific reserved criteria: examples include medications reserved for patients with documented allergy to the generic, reserved for specific indications (eg, oncology, clotting disorders, PAH), or reserved for prescribers with specialty (eg, Behavioral Health)."},
{"text":"General reserved / required clinical criteria patterns: examples include requirement of inadequate response to two or more preferred products, documented contraindication to preferred products, documented failure or intolerance, and requirement for literature evidence of clinical benefit over preferred alternatives."},
{"text":"Long‑acting opioids (examples): fentanyl patches, hydromorphone ER, Hysingla — may have specific reserved criteria such as prior failure of shorter‑acting opioids, documentation of opioid‑tolerant status, and quantity/duration limits."},
{"text":"Reserved for inadequate response or contraindication to preferred products: many entries state ‘Reserved for patients with an inadequate response to two or more preferred products or with medical contraindications to their use. Documentation in the medical literature of clinical benefits over the preferred alternatives is required.’"},
{"text":"Drugs reserved for specific populations or indications: examples include pediatric age restrictions (eg, Aripiprazole products reserved for children ≤6 only when prescribed by Behavioral Health or previously stable), agents reserved for conditions such as chronic granulomatous disease, NHL with Mycosis fungoides/Sezary syndrome, PAH, or clotting disorders."},
{"text":"Agents with external or specific HealthPartners PA criteria links: numerous drugs list a HealthPartners PDF or the public coverage‑criteria search URL (examples in source: cancer drugs PDF, cytokine and CAM antagonists PDF, MHCP PA search page)."},
{"text":"Miscellaneous single‑drug reservations: examples include products reserved for documented allergic reaction to equivalent generic (eg, Acanya, Actonel, Addreall XR examples), requirement for on‑site airway management for ADASUVE self‑administration, or other product‑specific operational requirements."},
{"text":"General Nonpreferred Drug Prior Authorization Requirement: drugs listed require PA per MN DHS nonpreferred criteria; the specific criteria per drug may be a linked HealthPartners document or the general rule requiring prior authorization."},
{"text":"Drug‑specific required clinical criteria examples: the source captures entries such as Aemcolo reserved when both indication criteria are met and for patients with inadequate response to ciprofloxacin/azithromycin; ADASUVE reserved for psychomotor agitation with prior failure of preferred antipsychotics plus rationale for self‑administration and facility‑level airway resources; ADUHELM references HealthPartners search page for required clinical criteria."},
{"text":"Generic MHCP Non‑Preferred Drug PA Requirements (applies per listed drug): where the entry references MHCP or MN DHS, the MHCP nonpreferred PA rules apply in addition to any HealthPartners product‑specific requirements."},
{"text":"Per‑drug prior authorization/reservation criteria (listing): each drug entry in the source either (a) references a HealthPartners PDF/link for full criteria, (b) states reserved uses (eg, inadequate response to preferred agents, allergy to generic, population‑specific restrictions), or (c) provides brief examples of required documentation or operational notes. Providers should not rely solely on the brief listing — consult the linked document for complete PA instructions."},
Drug‑Specific Reserved or Linked Criteria: the source includes numerous exact drug examples with either explicit short reservation language or a link to a HealthPartners PDF (eg, Abiraterone acetate → cancer drugs PDF; Actemra → cytokine and CAM antagonists PDF; Adcirca/Adempas → PAH PDF; Advate/Adynovate → clotting disorders PDF).