Limited coverage drugs – saxagliptin and saxagliptin-metformin

Generic name	saxagliptin	saxagliptin-metformin
Strength	2.5 mg 5 mg	2.5 mg/500 mg 2.5 mg/850 mg 2.5 mg/1000 mg
Form	tablet	tablet

Special Authority criteria	Approval period
As part of a combination treatment for type 2 diabetes mellitus: After inadequate glycemic control on maximum tolerated doses of dual therapy of metformin and a sulfonylurea or dual therapy of metformin and an insulin.	Indefinite

Practitioner exemptions

• None

Special notes

• Patients intolerant to a sulfonylurea may be considered for coverage.
• Patients intolerant to glyburide may try another sulfonylurea (e.g., gliclazide, which is available through the PharmaCare Special Authority program).
• Patients who meet the Limited Coverage criteria for saxagliptin automatically receive coverage for linagliptin.

Special Authority requests

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• HLTH 5481 - Third-Line Anti-Diabetic Drugs (PDF, 672KB)