dapagliflozin propanediol/metformin HCl

10 mg-1,000 mg, 10 mg-500 mg, 2.5 mg-1,000 mg, 5 mg-1,000 mg, 5 mg-500 mg — Extended Release Tablet

DIABETES NON-INSULIN

Also known as: XIGDUO XR DAPAGLIFLOZIN-METFORMIN ER

Coverage by Insurer

Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.
Source: Excel (XLSX)  ·  Formulary date: Jan 5, 2026  ·  Checked: 16 hours, 11 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
TRICARE Uniform Formulary 2026 Tier 3 - Non-Formulary PA
Something not right?