saxagliptin

2.5 MG — Tablet

Hypoglycemics - Oral — 2nd Generation Sulfonylureas

Also known as: Onglyza Saxagliptin 2.5 Mg Tablet Saxagliptin 5 Mg Tablet

Ambetter (Centene)

29 plans

Source: CMS QHP JSON · Formulary date: Jan 1, 2026 · Checked: 11 hours ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Standard Gold with Atrium Health + Vision + Adult Dental	Tier 2 - Generic	—	—	✓	QL
Standard Silver with Atrium Health	Tier 2 - Generic	—	—	✓	QL
Standard Gold with Atrium Health	Tier 2 - Generic	—	—	✓	QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental	Tier 2 - Generic	—	—	✓	QL
Complete Gold + Vision + Adult Dental	Tier 2 - Generic	—	—	✓	QL
Everyday Bronze + Vision + Adult Dental	Tier 2 - Generic	—	—	✓	QL
Elite Bronze + Vision + Adult Dental	Tier 2 - Generic	—	—	✓	QL
Everyday Bronze with Atrium Health + Vision + Adult Dental	Tier 2 - Generic	—	—	✓	QL
Elite Bronze with Atrium Health + Vision + Adult Dental	Tier 2 - Generic	—	—	✓	QL
Focused Silver with Atrium Health + Vision + Adult Dental	Tier 2 - Generic	—	—	✓	QL
Complete Gold with Atrium Health + Vision + Adult Dental	Tier 2 - Generic	—	—	✓	QL
Standard Expanded Bronze + Vision + Adult Dental	Tier 2 - Generic	—	—	✓	QL
Standard Silver + Vision + Adult Dental	Tier 2 - Generic	—	—	✓	QL
Standard Gold + Vision + Adult Dental	Tier 2 - Generic	—	—	✓	QL
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental	Tier 2 - Generic	—	—	✓	QL
Standard Silver with Atrium Health + Vision + Adult Dental	Tier 2 - Generic	—	—	✓	QL
Complete Gold	Tier 2 - Generic	—	—	✓	QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options	Tier 2 - Generic	—	—	✓	QL
Everyday Bronze	Tier 2 - Generic	—	—	✓	QL
Elite Bronze	Tier 2 - Generic	—	—	✓	QL
Clear Silver with $0 Insulin Options	Tier 2 - Generic	—	—	✓	QL
Standard Expanded Bronze	Tier 2 - Generic	—	—	✓	QL
Standard Silver	Tier 2 - Generic	—	—	✓	QL
Standard Gold	Tier 2 - Generic	—	—	✓	QL
Everyday Bronze with Atrium Health	Tier 2 - Generic	—	—	✓	QL
Elite Bronze with Atrium Health	Tier 2 - Generic	—	—	✓	QL
Focused Silver with Atrium Health	Tier 2 - Generic	—	—	✓	QL
Complete Gold with Atrium Health	Tier 2 - Generic	—	—	✓	QL
Standard Expanded Bronze with Atrium Health	Tier 2 - Generic	—	—	✓	QL

Cigna

1 plan

Source: PDF · Formulary date: Jan 1, 2026 · Checked: 11 hours ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Cigna Plus NC 4-Tier Formulary 2026	Tier 1 - Generic	—	—	✓	QL

Medicare Part D

9 plans

Source: CMS QHP JSON · Formulary date: Mar 18, 2026 · Checked: 11 hours ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Longevity Health Plan (HMO I-SNP)	Tier 1 - Preferred Generic	—	—	✓ 30 per 30 days	QL
Wellcare Dual Liberty (HMO-POS D-SNP)	Tier 3 - Preferred Brand	—	—	✓ 30 per 30 days	QL
Wellcare Dual Access (HMO-POS D-SNP)	Tier 3 - Preferred Brand	—	—	✓ 30 per 30 days	QL
Wellcare Simple Open (PPO)	Tier 3 - Preferred Brand	—	—	✓ 30 per 30 days	QL
Wellcare Simple (HMO-POS)	Tier 3 - Preferred Brand	—	—	✓ 30 per 30 days	QL
Wellcare Giveback Open (PPO)	Tier 3 - Preferred Brand	—	—	✓ 30 per 30 days	QL
Wellcare Assist Open (PPO)	Tier 3 - Preferred Brand	—	—	✓ 30 per 30 days	QL
Wellcare Dual Liberty Open (PPO D-SNP)	Tier 3 - Preferred Brand	—	—	✓ 30 per 30 days	QL
Wellcare Dual Reserve (HMO-POS D-SNP)	Tier 3 - Preferred Brand	—	—	✓ 30 per 30 days	QL

NC Medicaid PDL

2 plans

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 11 hours ago

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

NC State Health Plan

3 plans