saxagliptin HCl/metformin HCl

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

Also known as: KOMBIGLYZE XR SAXAGLIPTIN-METFORMIN ER

Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.

1 plan

Source: Excel (XLSX) · Formulary date: Jan 5, 2026 · Checked: 1 hour, 58 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
TRICARE Uniform Formulary 2026	Tier 3 - Non-Formulary	✓	—	—	PA

1 plan

Source: PDF · Formulary date: Jan 1, 2026 · Checked: 1 hour, 58 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
UnitedHealthcare NC Individual & Family 2026 via saxagliptin-metformin er	Unknown	—	—	✓	QL