CurrentHealthPartnersPolicy N/A

Basic HSA Preventive Drug List

Defines the list of medications considered HSA Preventive for HealthPartners high deductible health plans paired with Health Savings Accounts; describes which drugs may be purchased for a copay before the deductible and who should check plan details.

Policy Summary

PayerHealthPartners

PolicyBasic HSA Preventive Drug List

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionCheck the member's plan documents and the Pharmacy Drug List (Formulary) for complete coverage rules; some listed products require prior authorization or have quantity limits.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

HSA-eligibleplan applicability

~17+insulin products listed

PA/QL presentcoverage rule annotations

multipletherapeutic classes

HSA Preventive Coverage Criteria

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HSA Preventive coverage conditions: Member is enrolled in an employer-offered high deductible health plan intended to be paired with a Health Savings Account (HSA) AND the medication appears on this preventive drug list (a subset of the HealthPartners formulary)

Plan documents govern if there is a conflict; additional formulary coverage rules (e.g., prior authorization or quantity limits) may apply — see the Pharmacy Drug List (Formulary) and the 'More Details' column for specific products.

This document describes which medications are covered as HSA Preventive drugs for members enrolled in an employer-offered high deductible health plan that is intended to be paired with a Health Savings Account (HSA). Coverage as HSA Preventive applies when the member’s plan is HSA-eligible and the employer offers the HDHP paired with an HSA; the preventive drug list is a subset of the HealthPartners formulary and is reviewed periodically. If there is any conflict between this general information and a member’s plan documents, the plan documents determine coverage.

Drug and Supply Listings / Coding

Diabetes supply gauge/length annotationsmixed

29G	needle gauge referenced in product descriptions (e.g., 12MM 29G pentip)
30G	needle gauge referenced in product descriptions (e.g., 30G lancet)
31G	needle gauge referenced in product descriptions
32G	needle gauge referenced in product descriptions
33G	needle gauge referenced in product descriptions
4MM	needle length referenced in product descriptions
5MM	needle length referenced in product descriptions
6MM	needle length referenced in product descriptions
8MM	needle length referenced in product descriptions
12MM	needle length referenced in product descriptions

Cardiovascular drug namesmixedCovered

furosemide	loop diuretic — multiple formulations/strengths listed
bumetanide	loop diuretic — strengths listed
torsemide	loop diuretic — strengths listed
hydrochlorothiazide	thiazide diuretic — strengths listed
chlorthalidone	thiazide-like diuretic — strengths listed
amiloride	potassium-sparing diuretic — strengths listed
spironolactone	mineralocorticoid antagonist — strengths listed

Insulin productsmixedCovered

insulin glargine 100 unit/ml	long-acting insulin — product listing
insulin glargine max solo u300	concentrated long-acting insulin listed
LANTUS 100 UNIT/ML VIAL	brand long-acting insulin
LEVEMIR 100 UNIT/ML VIAL	brand long-acting insulin (annotated PA)
HUMALOG 100 UNIT/ML	rapid-acting insulin formulations listed
insulin aspart 100 unit/ml	rapid-acting insulin (some entries annotated PA)
HUMULIN R 100 UNIT/ML VIAL	short-acting insulin listed

Prior Authorization, Quantity Limits, and Provider Notices

Documentation Required

Plan documentation check

Check plan documents and the Pharmacy Drug List (Formulary) for complete coverage rules. If there is any difference between this summary and your plan documents, the plan documents govern. Members and providers should verify benefit specifics and any employer‑specific plan design before prescribing or dispensing.

See the Pharmacy Drug List (Formulary) for full coverage details and any plan‑level exceptions.

Step Therapy

Step therapy / QL indicators

Some medications listed on the drug list include QL (quantity limit) or step therapy indicators. These flags mean there may be quantity limits or a step‑therapy requirement: confirm the specific rules on the Pharmacy Drug List before prescribing or dispensing.

QL = quantity limit applies for one or more strengths/formulations.
Step therapy flags require trials of specified agents prior to coverage of the listed product.

Prior Authorization

Prior authorization indicated

Certain items are annotated with PA, indicating prior authorization is required. Prior authorization may require clinical documentation and must be approved before the medication is covered. Examples include select insulin pen and vial products (e.g., some Levemir and insulin aspart listings) and specific incretin mimetics noted with PA/QL; see the Pharmacy Drug List for the full PA list and submission details.

PA = prior authorization required; submit supporting clinical information per payer requirements.
Examples: Levemir products and insulin aspart formulations are marked PA in the insulin section.
Incretin mimetics such as liraglutide, Mounjaro, and Rybelsus include PA and/or QL annotations in the formulary extract.

Denial Risk

Coverage and denial risk

Coverage rules and prior authorization requirements may apply and are not exhaustively presented here. Failure to obtain required prior authorization or to follow quantity/step‑therapy rules may result in claim denial or member financial responsibility.

Confirm coverage and prior authorization requirements before ordering or dispensing to reduce denial risk.
When in doubt, contact HealthPartners Provider Services or reference the member's plan documents and the Pharmacy Drug List.

Background and Context

Preventive medications are intended to help avoid disease and maintain health. For members in an HSA-eligible high deductible health plan that is designed to be paired with an HSA, medications on the preventive drug list may be purchased for a copay rather than being applied to the deductible. This list was developed in accordance with federal guidance and is a subset of the HealthPartners drug formulary; it is reviewed periodically and members should check plan documents for current details.

Key Definitions

Preventive drug

DefinitionMedications used to help avoid disease and maintain health; when a member is enrolled in an employer-offered high deductible health plan intended to be paired with a Health Savings Account (HSA), these medications on the preventive drug list may be purchased for a copay rather than being applied to the plan deductible.

List relationshipThe preventive drug list is a subset of the HealthPartners drug formulary and is reviewed periodically; plan documents govern if there is a difference.

HSA/HDHP applicabilityApplies when the employer offers an HSA-eligible HDHP and the member is enrolled in that plan — check plan details or Member Services to confirm eligibility.

PurposeAligns with federal guidance to identify medications eligible for preventive copay treatment under qualifying HSA-paired HDHPs.

PA (Prior Authorization)

DefinitionPA indicates Prior Authorization — an annotation present next to some products meaning documentation and authorization may be required before the product is covered.

Provider actionItems annotated 'PA' suggest prior authorization submission and supporting documentation will be required; consult the formulary entry for product-specific requirements.

Examples in listCertain insulin products are annotated 'PA' in the listing (e.g., LEVEMIR entries; some insulin aspart pen/vial entries).

Step Therapy and Authorization Tables

Medication / Group	Step therapy / QL/PA indicator
JENTADUETO (DPP-4 combination)
JENTADUETO XR
TRADJENTA (linagliptin)
liraglutide (incretin mimetic)
MOUNJARO (tirzepatide)
RYBELSUS (oral semaglutide)

Insulin product	Prior authorization required?
LEVEMIR 100 UNIT/ML VIAL
LEVEMIR FLEXPEN 100 UNIT/ML
insulin aspart 100 unit/ml cartridge
insulin aspart 100 unit/ml pen
insulin aspart 100 unit/ml vial
LANTUS 100 UNIT/ML VIAL
insulin glargine 100 unit/ml

Quantity Limits

Multiple listed products (QL annotations)

Meaning of QL'QL' on the formulary denotes a quantity limit for the specified product — check the formulary 'MORE DETAILS' entry for the exact limit and per‑period rules.

Where shownMultiple products in the preventive list include 'QL' annotations (examples include JENTADUETO, JENTADUETO XR, TRADJENTA and various glucagon/GVOKE items).

Action for providersReview the Pharmacy Drug List entry for a product's 'QL' details prior to prescribing or dispensing to ensure the quantity requested is within allowed limits.