Zituvio — Medica
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 (generic metformin or generic metformin extended-release [generic to Glucophage XR only]); OR
- Patient has tried one of the following metformin-containing products: Fortamet ER (obsolete), Glucophage (obsolete), Glucophage XR (obsolete), Glumetza ER, Riomet, metformin oral solution, Riomet ER (obsolete), metformin extended-release (generics to Fortamet ER and Glumetza ER), glyburide/metformin, glipizide/metformin, Actoplus Met, pioglitazone/metformin, Actoplus Met XR (obsolete), repaglinide/metformin (obsolete), Invokamet, Invokamet XR, Synjardy, Synjardy XR, Xigduo XR, dapagliflozin/metformin extended-release, Segluromet; OR
- Patient has tried one Step 2 Product; OR
- Patient is initiating dual (combination) therapy with a single-entity DPP-4 inhibitor (Januvia, Onglyza, saxagliptin, Tradjenta, Nesina, alogliptin, Zituvio, or sitagliptin [authorized generic to Zituvio]) AND metformin; OR
- Patient has a contraindication to metformin, according to the prescriber (examples include acute or chronic metabolic acidosis, including diabetic ketoacidosis).
Approval duration
1 year