alogliptin benz/metformin HCl

12.5-1000, 12.5-500MG — Tablet

Also known as: KAZANO ALOGLIPTIN-METFORMIN

Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.

2 plans

Source: PDF · Formulary date: Oct 1, 2026 · Checked: 8 hours, 30 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC Medicaid Preferred Drug List 2026 via alogliptin-metformin	Non-Preferred	—	—	—	None
NC Medicaid Preferred Drug List 2026 via Kazano	Non-Preferred	—	—	—	None

2 plans

Source: Excel (XLSX) · Formulary date: Oct 29, 2026 · Checked: 8 hours, 30 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
TRICARE Uniform Formulary 2026 via alogliptin-metformin	Tier 3 - Non-Formulary	—	✓	—	ST Step therapy: 9DPP-4 INHIBITORS SECONDARY RULE- SEL DPP-4 INHIBITORS REQ PA W/O SELECT ANTI-HYPREGLYCEMIC
TRICARE Uniform Formulary 2026 via Kazano	Tier 3 - Non-Formulary	—	✓	—	ST Step therapy: 9DPP-4 INHIBITORS SECONDARY RULE- SEL DPP-4 INHIBITORS REQ PA W/O SELECT ANTI-HYPREGLYCEMIC