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
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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.
Cigna
20 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
Connect Bronze CMS Standard
via saxagliptin-metformin er |
Tier 2 - Generic | — | — | ✓ | QL |
|
Connect Silver RD CMS Standard
via saxagliptin-metformin er |
Tier 2 - Generic | — | — | ✓ | QL |
|
Connect Gold CMS Standard
via saxagliptin-metformin er |
Tier 2 - Generic | — | — | ✓ | QL |
|
Connect Bronze RD CMS Standard
via saxagliptin-metformin er |
Tier 2 - Generic | — | — | ✓ | QL |
|
Connect Gold RD CMS Standard
via saxagliptin-metformin er |
Tier 2 - Generic | — | — | ✓ | QL |
|
Connect myDiabetesCare Silver
via saxagliptin-metformin er |
Tier 2 - Generic | — | — | ✓ | QL |
|
Connect Silver RD 2200 Indiv Med Deductible
via saxagliptin-metformin er |
Tier 2 - Generic | — | — | ✓ | QL |
|
Connect Gold 1500 Indiv Med Deductible
via saxagliptin-metformin er |
Tier 2 - Generic | — | — | ✓ | QL |
|
Connect myDiabetesCare Bronze
via saxagliptin-metformin er |
Tier 2 - Generic | — | — | ✓ | QL |
|
Connect Bronze 5500 Indiv Med Deductible
via saxagliptin-metformin er |
Tier 2 - Generic | — | — | ✓ | QL |
|
Connect Bronze RD 6000 Indiv Med Deductible
via saxagliptin-metformin er |
Tier 2 - Generic | — | — | ✓ | QL |
|
Connect Silver 3500 Indiv Med Deductible
via saxagliptin-metformin er |
Tier 2 - Generic | — | — | ✓ | QL |
|
Connect Bronze RD 5000 Indiv Med Deductible
via saxagliptin-metformin er |
Tier 2 - Generic | — | — | ✓ | QL |
|
Connect Silver RD 3500 Indiv Med Deductible
via saxagliptin-metformin er |
Tier 2 - Generic | — | — | ✓ | QL |
|
Connect Bronze 7000 HSA Indiv Med Deductible
via saxagliptin-metformin er |
Tier 2 - Generic | — | — | ✓ | QL |
|
Connect Silver 4400 Indiv Med Deductible
via saxagliptin-metformin er |
Tier 2 - Generic | — | — | ✓ | QL |
|
Connect Silver RD 5000 Indiv Med Deductible
via saxagliptin-metformin er |
Tier 2 - Generic | — | — | ✓ | QL |
|
Connect Silver 3000 Indiv Med Deductible
via saxagliptin-metformin er |
Tier 2 - Generic | — | — | ✓ | QL |
|
Connect Bronze 6500 Indiv Med Deductible
via saxagliptin-metformin er |
Tier 2 - Generic | — | — | ✓ | QL |
|
Connect Silver CMS Standard
via saxagliptin-metformin er |
Tier 2 - Generic | — | — | ✓ | QL |
Medicare Part D
3 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
Longevity Health Plan (HMO I-SNP)
via saxagliptin-metformin er |
Tier 1 - Preferred Generic | — | — | ✓ 30 per 30 days | QL |
|
Wellcare Giveback Open (PPO)
via saxagliptin-metformin er |
Tier 3 - Preferred Brand | — | — | ✓ 30 per 30 days | QL |
|
Wellcare Dual Reserve (HMO-POS D-SNP)
via saxagliptin-metformin er |
Tier 3 - Preferred Brand | — | — | ✓ 30 per 30 days | QL |