Brenzavvy — Cigna

chronic kidney disease

Preferred products

Coverage for a Step 2 Product requires that the patient has a history within the 130-day look-back period of ONE of the following: (a) one Step 1 Product OR (b) one of the listed metformin-containing products (Glumetza ER, Riomet, metformin oral solution, metformin extended-release [generics to Fortamet ER and Glumetza ER], glyburide/metformin, glipizide/metformin, Actoplus Met, pioglitazone/metformin, Kazano, alogliptin/metformin, Jentadueto, Jentadueto XR, Kombiglyze XR, saxagliptin/metformin extended-release, Janumet, Janumet XR, sitagliptin/metformin [authorized generic to Zituvimet], Zituvimet, Zituvimet XR) OR (c) one Step 2 Product OR (d) one Step 3 Product.
Coverage for a Step 3 Product requires that the patient has a history within the 130-day look-back period of ONE Step 2 Product.

1 year