Limited coverage drugs – linagliptin and linagliptin-metformin

Generic name	linagliptin	linagliptin-metformin
Strength	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

1. 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).
2. Patients who meet the Limited Coverage criteria for linagliptin automatically receive coverage for saxagliptin.

Special Authority request form(s)

• Log in to eForms
• HLTH 5481 - Third-Line Anti-Diabetic Drugs (PDF, 672KB)