Audience: Providers of Impacted Members
All Sodium-Glucose Co-Transporter 2 (SGLT2) inhibitors are indicated as adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes and offer similar glycemic efficacy. Available treatment guidelines do not prefer one SGLT2 inhibitor over the others. In general, the therapy of first choice for most patients with type 2 diabetes is metformin (unless contraindicated) as adjunct to lifestyle modification. The SGLT2 inhibitors are regarded as add-on therapy (to metformin) when more than one agent is necessary to achieve glycemic control.
To ensure that we can continue to provide access to safe, effective and affordable medication, our Pharmacy & Therapeutics (P&T) committee has made the following change. Effective March 15, 2020 the following SGLT2 containing medications have been removed from our prescription drug formulary for members with Univera Healthcare MyHealthSM and MyHealth PlusSM. Please note that this change is not applicable to all formularies or all of your patients.
The alternative SGLT2 inhibitor that will be included on the formulary are Steglatro and Segluromet. Below is a chart showing the formulary products and the dosages available.
* Requires previous trial of metformin as suggested by treatment guidelines
We have notified members who filled a prescription for the impacted medications within the last four months. A list of your patients currently receiving these medications is provided below. We advised these members to talk with you about medications that are covered under their prescription drug benefit. Effective March 15, 2020, existing members who are currently receiving one of the non-formulary medications will no longer have coverage for the medications.
If you feel that the alternative formulary medications are not the right choice for your patient, you and your staff can request a coverage determination electronically, directly from your electronic medical record (EMR) or through CoverMyMeds ePA portal. Visit covermymeds.com for additional information on CoverMyMeds and electronic prior authorizations. Submission of the prior authorization form does not guarantee coverage.
As an alternative, you may complete a Managed Medicaid prior authorization form available at Provider.UniveraHealthcare.com > Authorizations > Authorization Request Forms > Standardized Prior Authorization Form – For Medicaid Managed Care. The completed form should be faxed to the plan for therapy consideration.
Thank you for discussing alternative medications with your patients when you feel that it is medically appropriate.
If you have any questions, please contact our Pharmacy Unit at 1-800-499-1275. To access all our drug formularies please see the website below.