Limited coverage criteria – linagliptin and linagliptin-metformin

Last updated on March 19, 2025

 

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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

  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 Special Authority)
  2. Patients who meet the limited coverage criteria for linagliptin automatically receive coverage for saxagliptin

Special Authority request form(s)