Limited coverage criteria – linagliptin and linagliptin-metformin

Last updated on March 2, 2026

 

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Generic name

Strength

Form

linagliptin 5 mg tablet
linagliptin-metformin

2.5 mg/500 mg
2.5 mg/850 mg
2.5 mg/1000 mg

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 who meet the limited coverage criteria for linagliptin automatically receive coverage for saxagliptin

Special Authority request form(s)