saxagliptin hcl
2.5 mg, 5 mg — Tablet
DIPEPTIDYL PEPTIDASE-4 (DPP-4) INHIBITORS
Also known as:
saxagliptin hcl tabs 2.5mg
saxagliptin hcl tabs 5mg
saxagliptin hcl tabs 2.5mg, 5mg
ONGLYZA
sAXagliptin HCl Oral Tablet
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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.
AmeriHealth Caritas NC
10 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| AmeriHealth Caritas Next Bronze Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 2 - Generic | — | — | ✓ | QL |
| AmeriHealth Caritas Next Bronze Essential + Three Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 2 - Generic | — | — | ✓ | QL |
| AmeriHealth Caritas Next Silver Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 2 - Generic | — | — | ✓ | QL |
| AmeriHealth Caritas Next Gold Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 2 - Generic | — | — | ✓ | QL |
| AmeriHealth Caritas Next Silver Off-Marketplace High + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 2 - Generic | — | — | ✓ | QL |
| AmeriHealth Caritas Next Silver Off-Marketplace Low + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 2 - Generic | — | — | ✓ | QL |
| AmeriHealth Caritas Next Silver Essential + Two Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 2 - Generic | — | — | ✓ | QL |
| AmeriHealth Caritas Next Silver Premier + No Referrals | Tier 2 - Generic | — | — | ✓ | QL |
| AmeriHealth Caritas Next Bronze Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 2 - Generic | — | — | ✓ | QL |
| AmeriHealth Caritas Next Gold Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 2 - Generic | — | — | ✓ | QL |
Blue Cross Blue Shield Federal
3 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| BCBS Federal Basic Option 2026 | Tier 1 - Generic | — | — | — | None |
| BCBS Federal Standard Option 2026 | Tier 1 - Generic | — | — | — | None |
| BCBS Federal Focus 2026 | Tier 1 - Generic | — | — | — | None |
Cigna
20 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| Connect Gold RD CMS Standard | Tier 2 - Generic | — | — | ✓ | QL |
| Connect Bronze 7000 HSA Indiv Med Deductible | Tier 2 - Generic | — | — | ✓ | QL |
| Connect Bronze 5500 Indiv Med Deductible | Tier 2 - Generic | — | — | ✓ | QL |
| Connect Gold CMS Standard | Tier 2 - Generic | — | — | ✓ | QL |
| Connect myDiabetesCare Silver | Tier 2 - Generic | — | — | ✓ | QL |
| Connect Bronze RD 5000 Indiv Med Deductible | Tier 2 - Generic | — | — | ✓ | QL |
| Connect Silver RD 5000 Indiv Med Deductible | Tier 2 - Generic | — | — | ✓ | QL |
| Connect Bronze CMS Standard | Tier 2 - Generic | — | — | ✓ | QL |
| Connect myDiabetesCare Bronze | Tier 2 - Generic | — | — | ✓ | QL |
| Connect Silver 5000 Indiv Med Deductible | Tier 2 - Generic | — | — | ✓ | QL |
| Connect Silver 3000 Indiv Med Deductible | Tier 2 - Generic | — | — | ✓ | QL |
| Connect Silver CMS Standard | Tier 2 - Generic | — | — | ✓ | QL |
| Connect Gold 1500 Indiv Med Deductible | Tier 2 - Generic | — | — | ✓ | QL |
| Connect Bronze RD 6000 Indiv Med Deductible | Tier 2 - Generic | — | — | ✓ | QL |
| Connect Bronze RD CMS Standard | Tier 2 - Generic | — | — | ✓ | QL |
| Connect Silver RD 3500 Indiv Med Deductible | Tier 2 - Generic | — | — | ✓ | QL |
| Connect Silver 3600 Indiv Med Deductible | Tier 2 - Generic | — | — | ✓ | QL |
| Connect Silver RD CMS Standard | Tier 2 - Generic | — | — | ✓ | QL |
| Connect Silver RD 2200 Indiv Med Deductible | Tier 2 - Generic | — | — | ✓ | QL |
| Connect Bronze 6500 Indiv Med Deductible | Tier 2 - Generic | — | — | ✓ | QL |
Medicare Part D
9 plans| 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 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 Liberty (HMO-POS 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 |
| Wellcare Dual Access (HMO-POS D-SNP) | Tier 3 - Preferred Brand | — | — | ✓ 30 per 30 days | QL |
NC State Health Plan
3 plans| 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 - HDHP 2026 | Tier 1 - Preferred Generic | — | — | — | None |
| NC State Health Plan - 70/30 Standard PPO 2026 | Tier 1 - Preferred Generic | — | — | — | None |