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Fast Facts Newsletter - August (Special Edition) 2025
HealthPartners·MN · Pain Management, Neurology, Orthopedics +2 more·Pharmacy
Effective date
Oct 1, 2025
We identified it
Jun 19, 2026
Summary
HealthPartners has updated their drug formulary with immediate changes affecting HIV PrEP/PEP medications, overactive bladder treatments, and medical policies for skilled nursing facilities and various procedures. Key changes include removing prior authorization for Descovy, formulary adjustments for Myrbetriq and Gemtesa, and new coverage criteria for specialized procedures effective October 1, 2025.
Action Required
By October 1, 2025: Update billing system and prior authorization workflows for intraosseous radiofrequency ablation of basivertebral nerve which now requires prior auth with specific criteria. Review and update encounter forms for skilled nursing facility admissions to align with new InterQual May 2025 criteria. Pharmacy team should update formulary information for emtricitabine/tenofovir (Descovy), mirabegron (Myrbetriq), and vibegron (Gemtesa) with new coverage and copay structures.