Janumet XR — Blue Cross Blue Shield of Alabama
Type 2 diabetes mellitus (DPP-4 inhibitor use)
Preferred products
- Alogliptin
- Alogliptin/metformin
- Alogliptin/pioglitazone
- Jentadueto
- Jentadueto XR
- Kazano
- Kombiglyze XR
- Nesina
- Onglyza
- Oseni
- Tradjenta
- Zituvimet
- Zituvimet XR
- Zituvio
Initial criteria
- ONE of the following:
- - The patient’s medication history includes use of a preferred DPP-4 inhibitor agent OR
- - The patient has an intolerance or hypersensitivity to sitagliptin that is not expected to occur with the requested agent OR
- - The patient has an FDA labeled contraindication to sitagliptin that is not expected to occur with the requested agent
- AND the patient will NOT be using the requested agent in combination with another DPP‑4 inhibitor/combination agent (e.g., Januvia, Janumet, Janumet XR, Jentadueto, Jentadueto XR, Kazano, Kombiglyze XR, Nesina, Onglyza, Oseni, Tradjenta, Zituvio, Zituvimet, Zituvimet XR) for the requested indication
- AND the patient will NOT be using the requested agent in combination with a GLP‑1 agent or GLP‑1/GIP receptor agonist (e.g., Saxenda, Wegovy, Zepbound, Bydureon, Byetta, Mounjaro, Ozempic, Rybelsus, Trulicity, Victoza)
Approval duration
12 months