SGLT2 Inhibitors

Drug - SGLT2 Inhibitors

July 2018

Therapeutic Area - Hypoglycemics

Single-entity Products

Preferred	Nonpreferred
Invokana Farxiga Jardiance	Steglatro

Preferred	Nonpreferred
None	Invokamet Invokamet XR Xigduo XR Synjardy Synjardy XR Segluromet Steglujan

Patient is 18 years of age or older AND
Patient must have a diagnosis of type 2 diabetes mellitus AND
Patient has not achieved adequate glycemic control on at least three of the following used separately or simultaneously:
- metformin (alone or in combination with a sulfonylurea or a thiazolidinedione);
- a sulfonylurea (alone or in combination with metformin);
- an oral DPP IV inhibitor (e.g., Januvia, Onglyza)
- a preferred GLP-1 receptor agonist AND
Patient has had an adequate adherent trial and failure of (or contraindication to) at least 2 preferred SGLT2 inhibitors

AND

Patient must not have any one of the following conditions:

Patient must meet ALL criteria for nonpreferred single entity products AND
Prescriber provides a compelling clinical reason why a fixed dose combination will provide superior efficacy than each component taken separately AND
If an extended release (XR) formulation is requested, prescriber provides a compelling clinical reason why the XR formulation will provide better clinical results than non-XR formulation

Single entity products and extended release formulation of fixed dose combination products: 34 tablets per 34 days
Fixed dose combination products: 68 tablets per 34 days

MHCP Provider Call Center 651-431-2700 or 800-366-5411