Onglyza

Generic: saxagliptin

2.5MG, 5MG — Tablet

Hypoglycemics - Oral — 2nd Generation Sulfonylureas

Also known as: ONGLYZA TABS 2.5MG, 5MG ONGLYZA TABS 5MG
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Coverage by Insurer

Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.
Source: CMS QHP JSON  ·  Formulary date: Jan 1, 2026  ·  Checked: 19 hours, 19 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Standard Gold with Atrium Health
via saxagliptin 		Tier 2 - Generic — — ✓ QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options
via saxagliptin 		Tier 2 - Generic — — ✓ QL
Everyday Bronze
via saxagliptin 		Tier 2 - Generic — — ✓ QL
Elite Bronze
via saxagliptin 		Tier 2 - Generic — — ✓ QL
Clear Silver with $0 Insulin Options
via saxagliptin 		Tier 2 - Generic — — ✓ QL
Standard Expanded Bronze
via saxagliptin 		Tier 2 - Generic — — ✓ QL
Standard Silver
via saxagliptin 		Tier 2 - Generic — — ✓ QL
Standard Gold
via saxagliptin 		Tier 2 - Generic — — ✓ QL
Everyday Bronze with Atrium Health
via saxagliptin 		Tier 2 - Generic — — ✓ QL
Elite Bronze with Atrium Health
via saxagliptin 		Tier 2 - Generic — — ✓ QL
Focused Silver with Atrium Health
via saxagliptin 		Tier 2 - Generic — — ✓ QL
Complete Gold with Atrium Health
via saxagliptin 		Tier 2 - Generic — — ✓ QL
Standard Expanded Bronze with Atrium Health
via saxagliptin 		Tier 2 - Generic — — ✓ QL
Standard Silver with Atrium Health
via saxagliptin 		Tier 2 - Generic — — ✓ QL
Complete Gold
via saxagliptin 		Tier 2 - Generic — — ✓ QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental
via saxagliptin 		Tier 2 - Generic — — ✓ QL
Complete Gold + Vision + Adult Dental
via saxagliptin 		Tier 2 - Generic — — ✓ QL
Everyday Bronze + Vision + Adult Dental
via saxagliptin 		Tier 2 - Generic — — ✓ QL
Elite Bronze + Vision + Adult Dental
via saxagliptin 		Tier 2 - Generic — — ✓ QL
Everyday Bronze with Atrium Health + Vision + Adult Dental
via saxagliptin 		Tier 2 - Generic — — ✓ QL
Elite Bronze with Atrium Health + Vision + Adult Dental
via saxagliptin 		Tier 2 - Generic — — ✓ QL
Focused Silver with Atrium Health + Vision + Adult Dental
via saxagliptin 		Tier 2 - Generic — — ✓ QL
Complete Gold with Atrium Health + Vision + Adult Dental
via saxagliptin 		Tier 2 - Generic — — ✓ QL
Standard Expanded Bronze + Vision + Adult Dental
via saxagliptin 		Tier 2 - Generic — — ✓ QL
Standard Silver + Vision + Adult Dental
via saxagliptin 		Tier 2 - Generic — — ✓ QL
Standard Gold + Vision + Adult Dental
via saxagliptin 		Tier 2 - Generic — — ✓ QL
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental
via saxagliptin 		Tier 2 - Generic — — ✓ QL
Standard Silver with Atrium Health + Vision + Adult Dental
via saxagliptin 		Tier 2 - Generic — — ✓ QL
Standard Gold with Atrium Health + Vision + Adult Dental
via saxagliptin 		Tier 2 - Generic — — ✓ QL
Source: CMS QHP JSON  ·  Formulary date: Jun 10, 2026  ·  Checked: 19 hours, 19 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Longevity Health Plan (HMO I-SNP)
via saxagliptin 		Tier 1 - Preferred Generic — — ✓ 30 per 30 days QL
Wellcare Dual Reserve (HMO-POS D-SNP)
via saxagliptin 		Tier 3 - Preferred Brand — — ✓ 30 per 30 days QL
Wellcare Simple Open (PPO)
via saxagliptin 		Tier 3 - Preferred Brand — — ✓ 30 per 30 days QL
Wellcare Simple (HMO-POS)
via saxagliptin 		Tier 3 - Preferred Brand — — ✓ 30 per 30 days QL
Wellcare Giveback Open (PPO)
via saxagliptin 		Tier 3 - Preferred Brand — — ✓ 30 per 30 days QL
Wellcare Dual Liberty Open (PPO D-SNP)
via saxagliptin 		Tier 3 - Preferred Brand — — ✓ 30 per 30 days QL
Wellcare Assist Open (PPO)
via saxagliptin 		Tier 3 - Preferred Brand — — ✓ 30 per 30 days QL
Wellcare Dual Access (HMO-POS D-SNP)
via saxagliptin 		Tier 3 - Preferred Brand — — ✓ 30 per 30 days QL
Wellcare Dual Liberty (HMO-POS D-SNP)
via saxagliptin 		Tier 3 - Preferred Brand — — ✓ 30 per 30 days QL
Source: PDF  ·  Formulary date: Jul 1, 2026  ·  Checked: 19 hours, 19 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC Medicaid Preferred Drug List 2026 Preferred — — — None
NC Medicaid Preferred Drug List 2026
via saxagliptin 		Non-Preferred — — — None
Source: PDF  ·  Formulary date: Jul 1, 2026  ·  Checked: 19 hours, 19 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - HDHP 2026 Not Covered — — — None
NC State Health Plan - 80/20 Plus PPO 2026 Not Covered — — — None
NC State Health Plan - 70/30 Standard PPO 2026 Not Covered — — — None
Source: PDF  ·  Formulary date: Jun 23, 2026  ·  Checked: 19 hours, 19 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
UHC Silver Value ($0 Virtual Urgent Care, No Referrals)
via saxagliptin 		Tier 3 - Preferred Brand — — ✓ QL
UHC Bronze Standard (No Referrals)
via saxagliptin 		Tier 3 - Preferred Brand — — ✓ QL
UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, No Referrals)
via saxagliptin 		Tier 3 - Preferred Brand — — ✓ QL
UHC Silver Value + ($0 Virtual Urgent Care, Dental + Vision, No Referrals)
via saxagliptin 		Tier 3 - Preferred Brand — — ✓ QL
UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals)
via saxagliptin 		Tier 3 - Preferred Brand — — ✓ QL
UHC Bronze Standard+ Dental + Vision (No Referrals)
via saxagliptin 		Tier 3 - Preferred Brand — — ✓ QL
UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals)
via saxagliptin 		Tier 3 - Preferred Brand — — ✓ QL
UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals)
via saxagliptin 		Tier 3 - Preferred Brand — — ✓ QL
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals)
via saxagliptin 		Tier 3 - Preferred Brand — — ✓ QL
UHC Gold Advantage + ($0 Virtual Urgent Care, $1 Tier 2 Rx, Dental + Vision, No Referrals)
via saxagliptin 		Tier 3 - Preferred Brand — — ✓ QL
UHC Bronze Essential ($0 Virtual Urgent Care, No Referrals
via saxagliptin 		Tier 3 - Preferred Brand — — ✓ QL
UHC Gold Standard (No Referrals)
via saxagliptin 		Tier 3 - Preferred Brand — — ✓ QL
UHC Silver Standard (No Referrals)
via saxagliptin 		Tier 3 - Preferred Brand — — ✓ QL
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