Steglujan — Cigna
Type 2 diabetes mellitus
Preferred products
- generic metformin
- generic metformin extended-release (generic to Glucophage XR only)
Initial criteria
- Patient has tried one Step 1 Product; OR
- Patient has tried one of the following 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, Janumet, Janumet XR, sitagliptin/metformin (authorized generic to Zituvimet), Zituvimet, Zituvimet XR, Kombiglyze XR, saxagliptin/metformin extended-release, Jentadueto, Jentadueto XR, Kazano, alogliptin/metformin, Synjardy, Synjardy XR, Xigduo XR, dapagliflozin/metformin extended-release, Invokamet, Invokamet XR, Segluromet; OR
- Patient has tried one of the following DPP-4 inhibitor products: Januvia, Nesina, alogliptin, Onglyza, saxagliptin, Tradjenta, Oseni, alogliptin/pioglitazone, Zituvio, sitagliptin (authorized generic to Zituvio); OR
- Patient has tried one SGLT-2 inhibitor (Brenzavvy, bexagliflozin, Farxiga, dapagliflozin [authorized generic to Farxiga], Invokana, Jardiance, Steglatro); OR
- Patient has a contraindication to metformin, according to the prescriber (e.g., acute or chronic metabolic acidosis, including diabetic ketoacidosis)
Approval duration
1 year