Limited coverage drugs – empagliflozin and empagliflozin-metformin
Special Authority requests can now be submitted online. It's simple and quick!
Learn more or log in.
Generic name |
empagliflozin |
empagliflozin-metformin |
---|---|---|
Strength |
|
|
Form |
tablet |
tablet |
Special Authority criteria |
Approval period |
---|---|
As part of treatment for type 2 diabetes mellitus:
|
Indefinite |
Practitioner exemptions
- None
Special notes
- A minimum three-month trial of metformin should be considered
- Coverage will be provided for either empagliflozin or an eligible dipeptidyl peptidase-4 (DPP-4) inhibitor
- For patients that have coverage for DPP-4 inhibitor, approval for empagliflozin coverage will result in discontinuation of coverage for DPP-4 inhibitor