dapagliflozin-saxagliptin

Generic: dapagliflozin/saxagliptin HCl

5 mg — Tablet

Sodium-Glucose Cotransporter 2 Inhibitor

Also known as: dapagliflozin-saxagliptin tab 10-5 mg

Coverage by Insurer

Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.
Source: PDF  ·  Formulary date: Jul 1, 2026  ·  Checked: 2 hours, 3 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - 80/20 Plus PPO 2026 Tier 1 - Preferred Generic None
NC State Health Plan - 70/30 Standard PPO 2026 Tier 1 - Preferred Generic None
NC State Health Plan - HDHP 2026 Tier 1 - Preferred Generic None
Source: Excel (XLSX)  ·  Formulary date: Jun 24, 2026  ·  Checked: 1 hour, 57 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
TRICARE Uniform Formulary 2026
via dapagliflozin/saxagliptin HCl
Tier 3 - Non-Formulary PA
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