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